Traditionally, the cap accounting year has ended October 31, putting the cap accounting year one month off of the Federal government fiscal year. In May 2015, CMS proposed to adjust the cap accounting year to end September 30 to align
Hospice Law Blog
News and Updates on Hospice Reimbursement Issues
The Hospice Law Blog, published by Sheppard, Mullin, Richter & Hampton LLP, focuses on legal and regulatory issues affecting hospice care providers. It covers topics such as hospice licensure and moratoriums, Medicare payment policies including hospice cap regulations and repayment demands, telehealth adaptations for hospice recertification, and the impact of federal legislation like the CARES Act on hospice operations. The blog also addresses challenges faced by hospices during public health emergencies, including COVID-19, discussing regulatory waivers, telehealth implementation, and patient care considerations. It provides updates on government oversight, compliance requirements, and policy changes relevant to hospice providers and stakeholders.
Latest from Hospice Law Blog - Page 3
CMS Issues Suggested Notice Of Election Statement
Following an OIG report on election statements in September, CMS has posted a suggested, but not mandatory, notice of election statement.
From inception of the benefit, hospices have been required to formulate their own notice of election. Regulations require…
ZPICs Terrorize, Close Hospices; CMS Blesses Approach
In recent months, ZPICs, tiring of the post-payment audit due process constraints imposed by Congress, have begun utilizing devastating and unlawful tools to put hospices, and presumably other providers, out of business – full payment suspension and full prepayment audit. …
OIG Issues Report On Hospice Election Statements
On September 16, 2016, the Office of Investigator General for CMS issued a report on hospice election statements, concluding that many of the statements in use by hospices are deficient in some respect. In its review of 565 election statements,…
CMS Proposes ALJ Hearing Changes
As most hospice providers know all too well, CMS faces an ever growing backlog of ALJ cases. This backlog stems in large part from aggressive audit procedures employed by ZPICs, RACs, and MACs that issue sweeping numbers of pre- and…
Hospice Cap Determination – 2015 Self Reporting Window Opening
Beginning February 1, the hospice cap self-reporting window (February through March) opens again.
Under regulations (42 C.F.R. § 418.308(c)), beginning last year, hospices are required to file reports in the February-March timeframe for the prior hospice cap year (e.g.,…
Hospice Notice of Election / Direct Data Entry Perils
In October 2014, Medicare adopted new policy (not a statute, not a regulation) requiring hospices to submit any notice of election within five days of admission. Medicare backed this policy (lacking any force of law) with substantial apparent teeth:…
Hospice Payment Changes Take Effect
With the advent of the 2016 (Happy New Year!), hospices now face the revised hospice payment system. Specifically, Medicare will pay a higher routine home care rate for the first 60 days of care ($187 average) and a lower routine…
Hospice False Claims Case Helps Clarify Law
Following a trial in which a national hospice chain (AseraCare) was initially found to have submitted false claims, the Court ordered a new trial. In making this rare order, the Court acknowledged that it had failed to provide the jury…
Hospice Cap Sequestration Update
In March 2015, CMS instructed its contractors to add sequestered funds, amounts never paid to providers, to revenue for purposes of calculating the hospice cap. This results in cap repayment demands that are overstated, in that they require repayment of…