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Medicare Claims for Unrelated Services Put Hospices at Risk

Hospice News

Medicare claims for unrelated services creates serious financial and legal risks for hospice providers — even if they are not the ones who sent the bill. During recent years, payouts for non-hospice services provided to Medicare beneficiaries have tipped into the billions. Centers for Medicare & Medicaid Services (CMS).

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3 Strategies for Hospice GIP Compliance

Hospice News

Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare.

Hospice 291
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New Red Flags Emerge in Hospice UPIC Auditing

Hospice News

Unified Program Integrity Contractor (UPIC) auditors are taking a sharper look at nursing home room-and-board for hospice patients. Centers for Medicare & Medicaid Services (CMS) contracts UPICs to investigate instances of suspected fraud, waste and abuse. We’ve found flaws in how they assemble the [claims] universe.”

Hospice 291
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HopeHealth CMO: Hospice Rules for ‘Unrelated Care’ Getting Stricter

Hospice News

We want to have money for our chaplains program and our bereavement services, and you could easily spend all of the money that we get from Medicare on pharmacy. There are certain areas that Medicare is focused on right now. So it’s not really a useful document. So we try to be judicious about that.

Hospice 280
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Hospice Medical Director Receives 50-Month Prison Sentence for $150M Fraud

Hospice News

“They enrolled patients with long-term incurable diseases such as Alzheimers and dementia as well as patients with limited mental capacity who lived at group homes, nursing homes and in housing projects.” All told, Merida personnel submitted 47,000 claims for more than 9,000 patients, totalling $152 million.

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Hospice Length of Stay: Balancing Patient Needs Against Regulatory Compliance

Hospice News

Are you in an outlier scenario with your data that Medicare contractors are looking at? Centers for Medicare & Medicaid Services (CMS) and the U.S. In 2020, the average length of stay for Medicare patients enrolled in hospice was 97.0 according to the Medicare Payment Advisory Commission. Young told Hospice News.

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Long-Term Care Nurse Fired for Not Falsifying Documentation

Nurse.com

A long-term care nurse shared that her facility was accused of negligence in failing to use bed rails properly to prevent residents from falling out of bed. . The RN did the assessment and documented her results. The administrator had another RN change the documentation done initially by the RN in question. She refused.