Hospice Insights: The Law and Beyond

The hospice physician plays an enormously critical role in hospice operations, from certifying patients as terminally ill to being the hospice’s representative in the community. Just as the physician’s role is critical, so too is the physician’s contract with the hospice. When it comes to contracting for a medical director’s or other hospice physician’s services, there are a variety of pitfalls to avoid and legal considerations to keep in mind. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton share their key tips for structuring hospice physician agreements.

The hospice certification of terminal illness is one of the documents most scrutinized by Medicare contractors, and it is of critical importance since an invalid certification can impact Medicare payment for the patient’s entire 90 or 60-day benefit period. If overlooking any of the multitude of certification requirements is human, then building redundancies into your certification documentation to avoid claim denials or a repayment obligation is divine. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton share key ideas for putting yourself in a more favorable position in the event your best-laid written certification plans go awry.

Husch Blackwell’s Meg Pekarske is joined today by Mary Kay Tyler, Chief Quality and Compliance Officer of Hospice of the Western Reserve, who shares strategies for achieving the elusive goal of improved clinical documentation. As Mary Kay discusses, you start with what can make the biggest impact. For general inpatient care (GIP), that is often physician and nurse practitioner (NP) documentation. Meg and Mary Kay discuss how she leveraged her electronic medical records (EMR), fostered buy-in, cultivated accountability, and remembered to listen throughout the process. We encourage you to take notes—you won’t want to miss any of these helpful tips.

Hospices are increasingly looking to buy, consolidate or merge to achieve administrative efficiencies and expand growth opportunities. Transactions between hospices present unique regulatory challenges that shape corporate and transactional structures, and often require looking beyond the client’s organizational charts. Join Husch Blackwell’s Meg Pekarske, Adam Royal and Erin Burns as they discuss key considerations and strategies in hospice transactions.

COVID-19 remained a substantial obstacle to hospices’ efforts to comply with quality data reporting obligations in 2021. Those challenges resulted in a number of hospices receiving notices of a 2% Medicare payment reduction in July 2022. We appealed those notices and won! In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Jacob Harris talk about those appeals, the keys to success and what to expect next year.

The hospice election may be the single most important document for hospices since an invalid form can impact payment for a patient’s entire stay. Especially in light of a recent rise in Medicare claim denials related to the election, revisiting your form now could save you later in time and money. In this episode, Husch Blackwell’s Meg Pekarske, Emily Solum and Andrew Brenton share some key tips for avoiding common election denials—and the headaches and sleepless nights that come with them.

For the last two-and-a-half years, hospices and other providers have been using billions in Provider Relief Fund (PRF) payments to prepare for, respond to and recover from the COVID-19 pandemic. The Office of Inspector General (OIG) has begun its nationwide audit of providers’ use of PRF payments, removing any remaining doubt as to whether these payments came with very significant strings attached. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Andrew Brenton share their experiences regarding the purpose and nature of the OIG audit and offer practical takeaways for hospices.

Husch Blackwell’s Meg Pekarske is very excited to be joined by Jaysen Roa, President and CEO of Avow Hospice in Naples, Florida. Jaysen is a leader of action who is finding new ways to approach and solve the challenges facing the hospice industry. He is leveraging technology to provide better and more responsive hospice care at the end of life. He is also collaborating with other hospices through the formation of Synthase Collaborative to improve efficiencies and work with new payors. Jaysen is a wonderful example of how a holistic mindset isn’t just reserved for bedside care but can be the foundation for creative problem solving, whether that be staffing challenges or pursuing new lines of business. Thank you so much for listening and we hope you enjoy the conversation. If you like our podcast, please subscribe and rate us!

In this episode, we continue our discussion of home health enforcement trends, focusing on other audits currently troubling agencies. These include audits from Unified Program Integrity Contractors (UPIC), Supplemental Medical Review Contractors (SMRC) and the Targeted Probe and Educate (TPE) program by the Centers for Medicare and Medicaid Services (CMS). As on the hospice side, these audits can be an administrative burden and should be taken seriously. Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Erin Burns talk about some of the types of home health audits they are currently seeing and strategies for response and appeal.

In a prior podcast, we alerted you to the Office of Inspector General’s (OIG) nationwide review of hospice beneficiary eligibility. The OIG has begun sending out requests for records to hospices across the country. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Erin Burns discuss what hospices can expect and what they should do.