Just as home health care has seen an increase in fraud cases by the Office of Inspector General (OIG), Federal Agencies are also likely to continue cracking down on hospice, as well.
Fortunately, there are “not a lot of subtleties” in where the government is likely to focus its efforts to root out fraud and improper billings, Schabes said during NAHC’s annual conference and expo in Long Beach, California.
For hospices to stay on top of the changes, Schabes laid out the top compliance risks—and some that might not be apparent:
—Technology compliance. Hospice agencies are faced with increasingly stricter reporting requirements with the introduction of Hospice Compare from the Centers for Medicare & Medicaid Services (CMS), which publicly displays star ratings, similar to home health care.
—Live discharges. Some studies have shown that hospices may be profit from live discharges, and the rate is rising. As this rate continues to rise, it may come with more scrutiny.
“[There is] no reason a live discharge is inherently wrong, but if there isa a large percentage, there are questions if they should have been in hospice in the first place,” Schabes said.
—Terminal Illness Documentation. Along with more inquiry into technology compliance and reporting efforts, documenting the terminal illness diagnosis is likely to see more review, as well, according to Schabes. Currently, Alzheimer’s can be listed as a primary diagnosis for terminal illness, but there will be more “heightened scrutiny for high rates of Alzheimer’s diagnosis and high lengths of stay,” Schabes said.
—Unbundling of Services. Increasingly, claims are being submitted outside the hospice benefit, according to Schabes. Submitting claims under Medicare Part D, when they should have been under hospice, is a growing problem area that will likely see more inspection from federal agencies.
Written by Amy Baxter