Hospice Insights: The Law and Beyond

While not new, the number and scope of Targeted Probe and Educate (TPE) reviews have soared to new heights. At the same time, more hospices are facing the uncomfortable position of moving to a second and sometimes third round of review. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki share how they have successfully navigated clients through the TPE process. In addition, they off...

In the midst of consolidation and restructuring among hospices, the Centers for Medicare & Medicaid Services (CMS) is scrutinizing initial enrollments and changes in ownership and management. In this episode, Husch Blackwell’s Meg Pekarske and Adam Royal discuss new and proposed changes to CMS’s provider enrollment screening and why it matters to hospices.

It’s been hard to keep track of all the new changes related to government oversight of hospices. This growing list now includes an expansion of the 36-month rule to hospices, which will limit the frequency that hospices can change ownership. There are important exceptions to the rule that all hospices will need to closely consider when evaluating all types of organizational changes, including trad...

Hospices have been the target of increased government scrutiny in 2023, and the Centers for Medicare and Medicaid Services (CMS) is planning to take further aim in 2024 through surveys. Join Husch Blackwell’s Meg Pekarske , Emily Solum , and Erin Burns as they talk about a cautionary survey tale and proposed changes to the hospice survey process, including the introduction of an informal dispute r...

Hospices are increasingly looking to buy, consolidate, or merge to achieve administrative efficiencies and expand operations for growth. A common approach among nonprofit hospices is to combine through a member substitution. In today’s episode, Husch Blackwell’s Meg Pekarske and Adam Royal discuss key considerations and strategies for hospice member substitutions.

A study published by NORC at the University of Chicago, a nonpartisan research organization, concluded that the Hospice Benefit saved Medicare $3.5 billion in 2019. The data behind that figure, and the study’s related findings, show that the value of the Medicare Hospice Benefit appears to be at odds with CMS’s regulatory priorities. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowick...

In the five-step audit appeals process, hospices often stop their appeal efforts after finding success at the third step, a hearing before an administrative law judge (ALJ). However, if an ALJ issues an unfavorable decision, the hospice still has recourse. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki talk about dealing with an unfavorable ALJ decision, including how to evaluat...

In this episode, Husch Blackwell’s Meg Pekarske and Jonathan Porter , a former federal prosecutor, discuss takeaways from the recent American Bar Association’s Annual National Institute on Health Care Fraud. Most importantly, they will explore what the hospice industry can expect after hearing the remarks of Lisa Miller, the Department of Justice’s (DOJ) Deputy Assistant Attorney General who overs...

Hospice professionals are often left wondering how the Centers for Medicare and Medicaid Services (CMS) and other government entities identify enforcement priorities. They also seek understanding about the subsequent steps taken for audits and False Claims Act investigations. In this episode, Husch Blackwell’s Meg Pekarske , Bryan Nowicki , and the hospice team’s newest member, former federal pros...

Audits that employ statistical extrapolation can turn a handful of claim denials into a liability of hundreds of thousands or millions of dollars. After years of relative quiet, the statisticians are back. The Centers for Medicare and Medicaid Services (CMS) also modified the rules relating to extrapolation in audits. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki review the lat...

Earlier this spring, as part of its annual rulemaking process for hospices, the Centers for Medicare and Medicaid Services (CMS) issued several important regulatory proposals. In addition to the yearly update in hospice per diem rates, the proposed rule clarifies the end dates for hospices to use telehealth and other technologies to provide remote care. The rule also contains a rather unpleasant s...

The HIPAA regulations require that covered entities enter into agreements with business associates who provide certain services for the covered entity involving the receipt, use, or disclosure of protected health information. In working with hospices throughout the years, we have found that many hospices have business associate agreements with nursing homes, vendors, and other providers where a bu...

The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reported in November 2022 that many providers are not complying with Medicare’s billing rules for advance care planning services. In large part, the OIG’s findings centered around providers failing to document separately for time spent on advance care planning versus time spent on concurrent services provided durin...

Payment suspension and overpayment extrapolation are among the most extreme and effective enforcement tools available to the Centers for Medicare and Medicaid Services (CMS) and its auditors. However, even these measures can be overcome. In this episode, Husch Blackwell’s Meg Pekarske , Bryan Nowicki , and Emily Solum talk about our hospice team’s latest encounter with payment suspension and extra...

The Centers for Medicare and Medicaid Services (CMS) unexpectedly proposed a rule change that could have a significant impact on how hospices investigate compliance issues and take remedial action. The rule change directly affects potential liability under the federal False Claims Act. Therefore, it is critical that hospices understand this change so they can take steps to mitigate risk and financ...

The Home Care 100 Leadership Conference is an annual gathering of top leaders and innovators in the hospice and home health community. Presentations and informal discussions address the current state of the industry and what will drive future survival and success. In this episode, Husch Blackwell’s Meg Pekarske , Bryan Nowicki and Emily Solum talk about their participation in this year’s conferenc...

While direct patient billing may be less common for hospice patients than for patients receiving hospital or other types of care, there are aspects of the No Surprises Act and its implementing regulations that are important for hospices to understand. In this episode, Husch Blackwell’s Meg Pekarske , Noreen Vergara and Andrew Brenton break down how the No Surprises Act applies to hospices. They al...

Recently, there has been an uptick in contractor participation at the administrative law judge (ALJ) stage of hospice audit appeals. This development poses unique challenges and new advocacy opportunities for providers. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki , Emily Solum and Zaina Niles about how hospices can prepare for and get the most out of contractor appeara...

The Department of Health and Human Services Office of the Inspector General (OIG) recently released a report detailing its evaluation of CMS’s primary fraud, abuse and waste investigators—the Unified Program Integrity Contractors (UPIC). In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki about the OIG’s report, what it reveals about UPIC activities, and what it means for the...

The hospice physician plays an enormously critical role in hospice operations, from certifying patients as terminally ill to being the hospice’s representative in the community. Just as the physician’s role is critical, so too is the physician’s contract with the hospice. When it comes to contracting for a medical director’s or other hospice physician’s services, there are a variety of pitfalls to...

The hospice certification of terminal illness is one of the documents most scrutinized by Medicare contractors, and it is of critical importance since an invalid certification can impact Medicare payment for the patient’s entire 90 or 60-day benefit period. If overlooking any of the multitude of certification requirements is human, then building redundancies into your certification documentation t...

Husch Blackwell’s Meg Pekarske is joined today by Mary Kay Tyler , Chief Quality and Compliance Officer of Hospice of the Western Reserve, who shares strategies for achieving the elusive goal of improved clinical documentation. As Mary Kay discusses, you start with what can make the biggest impact. For general inpatient care (GIP), that is often physician and nurse practitioner (NP) documentation....

Hospices are increasingly looking to buy, consolidate or merge to achieve administrative efficiencies and expand growth opportunities. Transactions between hospices present unique regulatory challenges that shape corporate and transactional structures, and often require looking beyond the client’s organizational charts. Join Husch Blackwell’s Meg Pekarske , Adam Royal and Erin Burns as they discus...

COVID-19 remained a substantial obstacle to hospices’ efforts to comply with quality data reporting obligations in 2021. Those challenges resulted in a number of hospices receiving notices of a 2% Medicare payment reduction in July 2022. We appealed those notices and won! In this episode, Husch Blackwell’s Meg Pekarske , Bryan Nowicki and Jacob Harris talk about those appeals, the keys to success...

The hospice election may be the single most important document for hospices since an invalid form can impact payment for a patient’s entire stay. Especially in light of a recent rise in Medicare claim denials related to the election, revisiting your form now could save you later in time and money. In this episode, Husch Blackwell’s Meg Pekarske , Emily Solum and Andrew Brenton share some key tips...