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Stay Alert to the OIG Focus on Hospice Care

Posted on Wednesday, January 15, 2020 5:10 PM

While hospice is an amazing benefit for ‘end of life’ care, it too has come under scrutiny from the Office of Inspector General (OIG) as they identify potential fraud in some hospice organizations. In order to remain viable and continue to provide much needed ‘end of life’ care, it is important to be aware of where the OIG is focusing its’ efforts.
Over the past several years, the OIG has identified vulnerabilities in hospice programs. Through their projects, they have determined that “hospices do not always provide needed services to beneficiaries and sometimes provide poor quality care.” The OIG has also reported that “beneficiaries, their families and caregivers do not receive crucial information to make informed decisions about their care. Further, hospices’ inappropriate billing costs Medicare hundreds of millions of dollars.” This includes billing for a higher level of care when the beneficiary did not need it and not providing medications as required.
As a result, the OIG workplan has requested that CMS promote and enforce hospices’ compliance with the Conditions of Participation standards and for CMS to work more closely with State survey agencies and accreditation organizations to increase emphasis on oversight of the hospice requirements.
What does this mean for you? Increased scrutiny during surveys and new Targeted, Probe & Educate (TPE) projects!
In the November 2019 OIG publication, the OIG determined that Registered Nurses did not always visit Medicare Beneficiaries’ Homes at least every 14 days to assess the quality of care and services provided by hospice aides. These findings also noted that if the RN did visit the home every 14 days, there was no evidence of hospice aide supervision as required. https://oig.hhs.gov/oas/reports/region9/91803022.asp
In August 2019, the OIG published findings that Medicare Part D is still paying millions for drugs already paid for under Part A Hospice Benefit. https://oig.hhs.gov/oas/reports/region6/61708004.asp
These recent findings may lead to TPEs for hospice programs with a focus on aide supervision and medications. It is best practice for hospices to be aware of current government focus and to provide education and supervision of the hospice interdisciplinary group to ensure compliance with all regulations.
Recent TPEs conducted as a result of OIG findings include the request for records to review hospice’s Notice of Election (NOE) and to review records for appropriate use of General Inpatient Care (GIP).  The NOE must contain crucial information to ensure that patients and caregivers can make informed decisions about their care. If the record reviewed did not contain all elements of the NOE, the entire claim was denied by the MAC. It was identified that many NOEs neglected to identify that hospice care was palliative, not curative, there was no evidence that the patient was given the opportunity to identify their attending physician and the NOE was not signed and/or not dated correctly. As a result of this probe, many hospices were subjected to further review.
The OIG also focused on the hospice GIP level of care. They noted that patients were on the GIP level of care for greater than 5 days and, in many cases, there were no visits by the hospice team during this time. Many hospices received requests for records with claims for the GIP level of care.
What can you do to prepare for the next round of TPEs?
Hospices should ensure that aides are supervised every 14 days and that the documentation of supervision includes evidence that the aide:

  • Is following the plan of care
  • Is competent in performing required tasks
  • Is satisfactory to the patient/family (Condition of Participation: 418.76(h)(3)).

Hospices should ensure that the Plan of Care includes a list of all the medications that the patient is taking, including over the counter medications. Since hospices must provide drugs and biologicals related to the palliation and management of the terminal illness and related conditions, it is recommended that the hospice identify which drugs and biologics the hospice is providing. (Condition of Participation 418.106 and Section 30.1 of the Medicare Benefit Policy Manual). As noted in recent OIG publications, hospices are not paying for drugs and biologicals related to the terminal illness.
Corridor is here to support you through and out of TPE rounds! 
Our team conducts record reviews to identify areas that may require additional focus by your agency. These reviews can be completed Pre-billing or as a QA project after billing was submitted. We can also assist with ADR management to ensure timely, accurate submissions! We can review the record prior to submission and assist with re-determinations as necessary.
Click here to learn how Corridor can help you successfully complete a TPE probe!


Written by: Debbie Plesich RN BSN COS-C
Director, Operational / Regulatory Consulting

About Corridor

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!

For additional information, please contact Corridor at 1-866-263-3795.

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