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January 25, 2018

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Medical Coding News Archives

Medicare Hospice Care

August 16, 2011:

Karen H. Kachur, RN, CPC

Medicare provides a comprehensive hospice care benefit for beneficiaries with a terminal illness and a life expectancy of six months or less. However, a recent Office of Inspector General (OIG) report demonstrated the evidence of fraud, abuse, and waste in this benefit.

Between the years of 2005 and 2009, payment for hospice services increased 53 percent, with payments for hospice care provided in nursing facilities increasing almost 70 percent during the same time period. In addition to more hospices, more than half of them were “for profit” in 2009, representing a substantial increase from 13 percent in 1992. It was found that compliance issues with hospice claims abound, with 82 percent of hospice claims for Medicare beneficiaries in nursing facilities not meeting Medicare coverage requirements in 2009. In addition, 63 percent of claims failed to meet the plan of care guidelines, which require the hospice to establish a plan of care for each beneficiary that includes the care to be provided, by whom it is provided, at what time, and for what purpose. A recent OIG investigation further discovered that hundreds of hospices had more than two-thirds of their patients residing in nursing facilities, and these patients were more likely to need less complex care than other beneficiaries over a longer period of time, resulting in larger profits.

CMS has been advised by the OIG to monitor hospices that depend heavily on nursing facility residents and to reduce Medicare payments for hospice care provided in nursing facilities.


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