Audits Underline Need for Caution Among Hospice Agencies

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Karen Utterback By Karen Utterback 
Former Vice President, Product Marketing and Strategy, McKesson (Retired)

Hospice Agency Readmittance PolicyAs the industry takes on new importance in today’s care environment, it’s critical that hospice agencies review and validate admission policies to stay in compliance.

The Health and Human Services Office of the Inspector General recently found that 82% of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements. The department’s fiscal year 2013 work plan detailed that statistic, noting that it would review hospices’ marketing materials and practices as well as their financial relationships with nursing facilities.

“MedPAC has also highlighted instances in which hospices aggressively marketed services to nursing facility residents,” the report states. “We will focus our review on hospices that have a high percentage of their beneficiaries in nursing facilities.”

A recent federal investigation into admission policies forced San Diego Hospice and the Institute for Palliative Medicine into bankruptcy, with plans to sell a majority of its assets to Scripps Health so patient care would not be interrupted while the hospice closed.

J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, indicated in a recent article that it’s clear more hospices are being investigated.

One reason hospice admittance policies need a review is the industry’s shift from a focus on cancer to conditions like Alzheimer’s disease and heart disease. As hospice executives know, although these conditions can be less expensive to treat, it can be harder to predict when those patients will die compared to those with cancer.

Tighter admitting criteria is not only necessary to avoid an audit, it’s also the best way to prevent having to discharge patients. Careful documentation is essential, too. If a patient’s life is extended beyond six months, he or she can only stay in a federally funded hospice program if he/she is re-certified as still likely to die within six months.

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