Big issues hospices should know about and learn from HH's PCR trials and tribulations Medicare hospice providers continue to draw attention from the Office of Inspector General and scrutiny from program integrity contractors due to improper payments. The implementation of the Medicare home health pre-claim review (PCR) process in 2016 represented a significant move by the Centers for Medicare & Medicaid Services (CMS) away from its historical “pay-and-chase” approach to a more effective and proactive strategy aimed at preventing illegitimate provider payments. While the PCR process has created significant hardships for home health providers, it has been deemed a success by CMS and is expected to continue to expand to other Medicare providers, including hospices.
By applying lessons learned from the PCR demonstration project, this session will focus on common hospice payment threats and documentation compliance risks, including election statements, general inpatient care documentation, notices of election, physician certifications and supporting documentation, and other coverage and payment conditions. Strategies for mitigating risks by leveraging the use of technology to more effectively monitor documentation processes will be examined, along with tactics for conducting proactive compliance audits.
Categories: Finance, Leadership, Quality, Regulatory