Eli's Hospice Insider

Published on Wed Mar 17, 2021 PDF

Recovery Audit Contractor Performant has announced that the Centers for Medicare & Medicaid Services approved CHC as a nationwide audit topic Feb. 1. “This review will determine if hospice Continuous Home Care services were reasonable and necessary to achieve palliation and management of the patient’s acute medical symptoms to maintain the terminally ill patient at home, based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied,” the RAC says on its audit issues webpage.

Performant can audit claims that have a “claim paid date” that is up to three years before the Additional Development Request (ADR) date, the RAC specifies. More details including revenue codes and HCPCS codes affected are at www.performantcorp.com/solutions/healthcare/cms-rac-resources/cms-approved-audit-issues/default.aspx..

Tune Up Your Documentation With New MAC Audit Tool Incorporating Addendum

If you want to bulletproof your hospice claims against Medicare denials, one HHH Medicare Administrative Contractor is offering an updated tool to help.

Palmetto GBA has posted a revised version of its Hospice Record Audit tool, the MAC says on its website. “This form will assist providers in auditing their medical records,” Palmetto says.

The tool is comprised of a 45-item checklist with “yes,” “no,” and “N/A” options, including an 11-item section on the new hospice addendum. One of the items: “It is titled ‘Patient Notification of Hospice Non-Covered Items, Services, and Drugs’?”

Access the updated tool at www.palmettogba.com/Palmetto/Providers.Nsf/files/Hospice_Documentation_Audit_Tool.pdf/$File/Hospice_Documentation_Audit_Tool.pdf..

Returned NOEs May Be In The System After All, Thanks To Glitch

Notice of Election submissions are confusing enough, but a new claims system glitch will make them even more so.

“Some hospice [NOEs] are posting the election to the Common Working File, but then Return to Provider (RTP) with reason code U5106,” reports HHH Medicare Administrative Contractor Palmetto GBA on its claims processing log.

The good news is that “the returned NOE involved with this issue will not affect sequential claims from processing” and “providers may submit sequential claims as normal,” Palmetto says.

Take A Look At List Of Largest Hospices

If you’re wondering who makes up the largest agencies in the fractured home health and hospice markets, wonder no longer.

LexisNexis Risk Solutions has issued its latest list of top 100 hospice and home health agencies using claims data from 2020. The list of the nation’s five largest hospice are VITAS Healthcare (4.42 percent of national market share), Kindred Health Care (2.86 percent), HCR Manor Care (2.16 percent), Amedisys Inc. (2.09 percent), and Seasons Hospice & Palliative Care (1.62 percent).

The top 100 hospice providers comprise more than 40 percent of the national market share, LexisNexis notes in an accompanying infographic.

Download the full top 100 lists and the infographic at https://risk.lexisnexis.com/insights-resources/research/2020-hospice-and-home-health-providers-report.