In the last few weeks our consultants have been working hard to assist hospices with claim denials resulting from UPIC and SMRC audit. The focus of these audits generally is review of Long Length of Stay Patients. Just today PGBA issued notification of the electronic comparative billing report (eCBR) explaining that data mining such as this allows them to identify trends and possible educational opportunities. Some of you may receive letters where the agency specific information is outside of normal range for Non-Cancer Length of Stay (NCLOS) Rates. Typically, these letters will suggest that hospices educate their staff and perform internal audits to ensure compliance with the Medicare Hospice Benefit requirements. CMS is using various tools to look for billing aberrations and trends to identify hospices for pre and post-payment medical review. The most prevalent risk areas will pertain to long-lengths of stay, non-cancer diagnoses and facility-based patients (SNF & ALF). It is critical that documentation from the hospice election to certification of terminal illness to plan of care and IDG team meetings to visit documentation is sufficient to meet standards and support that your patients qualify for the Medicare Hospice Benefit. Our team at SMART welcomes opportunities to work with hospice companies to be successful in meeting documentation requirements from providing educational seminars to provision of outsource coding, quality assurance and pre-billing audit reviews.

Are you prepared?