Eli's Hospice Insider
Proving Terminal Prognosis Continues To Trip Up Hospices In TPE
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Another quarter brings another round of dismal results. HHH Medicare Administrative Contractor CGS racked up another 100-percent failure rate for hospices under Targeted Probe and Educate medical review in the latest quarter. In the three months ended Dec. 31, 2018, MAC CGS completed seven TPE probes. They were all under the Length of Stay with Non-Oncologic Diagnosis edit (5D000). CGS medical reviewers found all seven hospices non-compliant, advancing them to round 2 of TPE. One of the hospices did not respond to Additional Development Requests for round 1, the MAC notes in an article updating its TPE results. “Terminal prognosis not supported” accounted for about 84 percent of the total TPE denials, CGS says. The second-most-common reason for denials, “subsequent certification not timely,” was well behind at about 4 percent of the total hospice TPE denials. See the results at www.cgsmedicare.com/hhh/pubs/news/2019/0119/cope11067.html.
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