As reiterated in the WPS Medicare Part B Legacy eNews, Medicare beneficiaries who elect hospice care, forego their rights to Medicare Part B payments for services related to treating and managing their terminal conditions, unless the services are provided by an attending physician. An “attending physician” is defined as a…
On September 22, 2010, the Office of Inspector General (“OIG”) released its Memorandum Report: Questionable Billing for Physician Services for Hospice Beneficiaries addressing a hospice billing vulnerability that cost CMS $566,000 in 2009. The OIG noted that there are instances of billing a single service under both Medicare Parts A…
CMS recently issued guidance on Section 2302 of the Patient Protection and Affordable Care Act–the 2010 healthcare reform law. “Section 2302 of the law amends sections 1905 (o)(1) and 2110(a)(23) of the Social Security Act to remove the prohibition of receiving curative treatment upon the election of the hospice benefit…
The Medicare hospice benefit is a fully reimbursable Medicare Part A benefit option, which covers the multidisciplinary services addressing the physical and emotional pain associated with terminal illness through palliative treatment. To be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare,…
Hospice providers are facing ongoing claims scrutiny, highlighting the importance of compliance. On June 8, 2010, the Centers for Medicare and Medicaid Services (“CMS”) held a national outreach session to educate hospice providers regarding specific vulnerabilities involving hospice services, with specific emphasis on the provision of hospice services to beneficiaries…
On June 7, 2010, the U.S. District Court for the Western District of Oklahoma held that a Department of Health and Human Services (HHS) regulation, 42 C.F.R. § 418.309(b), implementing a statutory cap on Medicare payments for hospice care was invalid and must be set aside (Compassionate Care Hospice v.…
Last week, the OIG released it’s Compendium of Unimplemented Recommendations that “consolidates significant unimplemented monetary and nonmonetary recommendations addressed to the Department of Health & Human Services (HHS) to provide information to interested parties about outstanding recommendations….” While these have not been implemented, it is something we want our clients…
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,…
When a beneficiary elects hospice care, s/he waives any Part B coverage related to that hospice care except for services rendered by an “attending physician.” An attending physician is defined as either a doctor of medicine, doctor of osteopathy or a nurse practitioner who is identified by the beneficiary as…
OIG released two reports examining the hospice benefit for residents of a nursing care facility. The first report, “determined the extent to which hospice claims for beneficiaries in nursing facilities met Medicare coverage requirements.” According to Section 418 of Title 42 of the Code of Federal Regulation, to receive Medicare…