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Recovery Audit Contractor (RAC) Issues Related to Hospice

Posted on Thursday, December 6, 2018 1:06 AM

Hospices should be aware of the following Recovery Audit Contractor (RAC) issues pertaining to hospice patients.

Physician Services During Hospice Period  – 8/16/2018
DME While in Hospice – 9/20/2018
Outpatient Hospice-Related Services – 11/28/2018

Medicare Hospice Benefits do not extend to non-hospice providers who provide services directly related hospice terminal diagnosis.  Even though hospice providers directly are not part of these approved RAC issues, certainly the relationships hospices have with the providers they often work with regularly could be impacted. It is not unreasonable to expect that a non-hospice provider subject to a RAC audit will go back to the hospice to question if the hospice is paying for all of the services it should be paying for under the Medicare Hospice Benefit or even to ask the hospice for money that the provider has to pay back as part of the RAC audit findings.

This is a good time for hospices to revisit their processes for determining what is related to the patient’s terminal diagnosis an making sure they covering what is related.

Source: NAHC Report

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