Medical Review, Technical Denials, and Enrollment Scrutiny

Howard Young will co-present with McBee Associates on hospice care issues and current hospice audit scrutiny.

For over a year, the hospice industry, legislators, and state and federal regulators have cautiously watched the rapid growth and potentially unscrupulous activities of new hospices, initially in California, then in Arizona, Nevada, and Texas.

On July 12, the Centers for Medicare & Medicaid Services (CMS) announced targeted oversight of new hospices in Arizona, California, Nevada, and Texas via a Medicare Learning Network fact sheet that allows for audits and prepay reviews of new hospices in those states.

This comes on the heels of CMS's recent regulatory proposals for additional hospice enrollment requirements and a Special Focus Program. CMS also introduced a new audit pilot program for nine diagnoses that it may suspect lead to a higher incidence of more clinically ineligible hospice patients.

But what does this additional hospice oversight mean, and what is CMS's vision for hospice care in 2024 and beyond?