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Hospice to OIG: Medication Billing Not So Simple

Posted on Monday, September 16, 2019 1:42 PM

The government recently claimed the hospice industry was improperly billing for medication, leading to Medicare paying for the same medications twice.  Hospices feel that they do not have the correct information on what should be covered. 

When a patient is admitted into hospice, the provider does a review of the patient’s current medications to see which ones are still needed or what should be added or eliminated. 

The complexity of this issue is best highlighted by example, a patient entering hospice who has cancer and diabetes, the hospice should cover the medications pertaining to palliative care but not the diabetes medications.  Unfortunately, the rules are complex and not clearly stated.

“The complexity is mind-boggling because there are so many parts to this,” said Judi Lund Person, vice president, regulatory and compliance, for the National Hospice & Palliative Care Organization (NHPCO). “The relationship between Part D and the Medicare Hospice Benefit is really hard to navigate, and [the U.S. Centers for Medicare & Medicaid Services (CMS)] said that they will not provide additional guidance on what should or should not be covered.”

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Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!

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