Eli's Hospice Insider
Scrutiny May Squeeze Referrals
Billing report contractor, ZPIC contact docs about home care and hospice referrals.
Reviewers peering over your referral sources’ shoulders may have a slowing effect on your referral stream.
Region 5 Zone Program Integrity Contractor (ZPIC) AdvanceMed sent notices earlier this month to both hospice and home health agency referral sources saying the ZPIC would ramp up oversight of them. “Referring providers will be under increased scrutiny related to referrals to hospice providers,” AdvanceMed says in the hospice notice. “Ensure that the beneficiaries referred to a hospice agency meet the criteria for the benefit,” particularly the six-month prognosis, the ZPIC instructs.
“Referring providers will be under increased scrutiny related to referrals to home health providers,” AdvanceMed says in the home health notice. “Ensure that the beneficiaries referred to a home health agency meet the criteria for the benefit,” particularly the skilled need and homebound status, the ZPIC specifies.
“The aged person who does not often travel from home because of feebleness and insecurity brought on by advanced age would not be considered confined to the home for purposes of receiving home health services unless they meet” the home health benefit criteria detailed in the letter, AdvanceMed stresses to referral sources in Zone 5 (Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia).
And comparative billing report contractor SafeGuard Services released its CBR on “Attending Providers Certifying Home Health Plan of Care” Aug. 29, the contractor says on its website.
The report displays the top 10 home health agencies a provider is associated with and the “Number of Beneficiaries Whose Plan of Care for Home Health Services Was Certified by You” compared to state and national peers in a bar chart.
Note: AdvanceMed’s hospice notice is at www.palmettogba.com/Palmetto/Providers.Nsf/files/Hospice_Referring_Provider.pdf/$File/Hospice_Referring_Provider.pdf.
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