Medicare Compliance & Reimbursement

If a recent OIG report about hospice nursing home patients isn't on your facility's radar screen, your staff may be missing an important risk management opportunity. OIG Memorandum Report, Medicare Hospice Care for Beneficiaries in Nursing Homes: Compliance with Medicare Coverage Requirements" (OEI-02-06-00221), found that a full 82 percent of all hospice claims for nursing home residents failed to meet at least one Medicare requirement, says attorney Mary Michal, with Reinhart Boerner Van Deuren in Madison, Wis. These included "failure to meet care planning requirements, or providing fewer services than set forth in the plan of care," says Michal.

So what does this have to do with your nursing home, if it cares for hospice patients? The F309 interpretive guidance talks about nursing homes coordinating care with the hospice and having a coordinated plan of care, says attorney Meg Pekarske, also with Reinhart Boerner Van Deuren. She has, in fact, worked with nursing facilities that have been cited because surveyors couldn't tell by looking at a resident's care plan that the person was on hospice.

Another vulnerability: The nursing home may also be in hot water if auditors or surveyors determine the resident did not receive medically necessary care specified by the care plan or otherwise, says attorney Paula Sanders, with Post & Schell in Harrisburg, Pa. Take This Proactive Step

What's the best way to protect yourself against hospicerelated shortfalls? Be strategic about selecting a hospice that the facility staff feels comfortable with, Pekarske suggests. For example, the hospice should "be responsive to patients' needs, involved in care planning -- and understand the nursing home business and regulatory requirements," she adds.

Example: If surveyors choose a hospice patient to review, "the hospice should be there to answer the surveyors' questions," Pekarske suggests. That's not just a smart move for patient care reasons, she adds.

"The nursing home interpretive guidance for F309 talks about surveyors" referring a hospice to its survey agency when they don't see the expected coordination of care, she says. "Thus, the hospice staff would want to be there to demonstrate that they are meeting the requirements so the nursing home surveyor doesn't make that referral."

More may be risky: Also keep in mind that contracting with too many hospices can make coordinating care difficult, Pekarske warns.

Editor's note: To read the complete OIG Memorandum Report, please visit: www.oig.hhs.gov/oei/reports/oei-02-06-00221.pdf