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OIG Report Found 81% of Hospice Claims Failed to Meet Documentation Requirements

All too often, services provided by hospices are denied by Medicare due to incomplete or inaccurate documentation practices that can easily be prevented.  A September report by the HHS Office of Inspector General analyzed some of the most common documentation inadequacies in hospice services provided to beneficiaries at nursing facilities, and the statistics are surprising.
 
According to the OIG report, the following mistakes were made: In 33 percent of claims, the election statement was either missing or failed to meet election statement requirements.  The most frequent problem was a failure to fully explain that the goal of hospice is palliative, not curative–meaning that beneficiaries are waiving certain services related to their terminal illnesses.  In 63 percent of claims, plans of care were inadequate–lacking an interdisciplinary approach or leaving out the scope of treatment or other requirements.  In 31 percent of claims, the services provided did not match the services outline in the plan of care.  In only 4 percent of cases was the problem certification, and in some of those cases, the issue was a failure to obtain a physician signature. 
 
In total, a startling 81 percent of claims in the OIG’s study sample did not completely meet coverage requirements.

For assistance with your hospice’s efforts to ensure full compliance with requirements, please see the HLP’s Hospice Provider page or contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 996-8510.

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