Hospice

This morning's MLN Newsletter included an article announcing the expansion of hospice prepayment review in four states.  The short article, "Hospice Benefit:  Expanding Prepayment Review in 4 States", consists of a few sentences and is not clear on exactly what 'expand' means.  It states:

To combat fraud, waste, and abuse under the hospice benefit, CMS will expand prepayment medical review this September in Arizona, California, Nevada, and Texas. To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results. 

If you're noncompliant, we may implement extended review or take additional administrative actions.

We have reached out to CMS' Center for Program Integrity (CPI) asking for clarification on which hospice providers are included in the expansion and how the expansion is going to be conducted - new hospice providers as defined in the June 2024 MLN Fact Sheet, all hospice providers or another subset of providers; is there a defined timeframe for the end of the expansion, will it only be the MACs that are conducting the prepayment review, etc.

We will provide an update here as more information is available. 

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Katie Wehri
Vice President of Regulatory Affairs, Quality & Compliance
NAHC
Washington, DC
202-240-9254 #3360
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We received an update on this today:

CMS is planning to have the Medicare Administrative Contractors (MACs) conduct prepayment medical review on existing Medicare-certified hospice providers in the four states - California, Arizona, Texas and Nevada.  The Agency describes it as a modification of the Targeted Probe & Educate initiative. Existing providers in these four states will be subject to a small claim sample being reviewed with individual education happening as necessary.  Providers in the states who have recently had TPE reviews conducted will be excluded by the MAC.  CMS is developing a Fact Sheet, which we hope to see released soon.

Specifics such as the size of the small claim sample and timeframe for the project as well as a date on which providers can expect to receive Additional Documentation Requests (ADRs) have not been shared.  We will provide updates here as information becomes available.

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Katie Wehri
Vice President of Regulatory Affairs, Quality & Compliance
NAHC
Washington, DC
202-240-9254 #3360
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Original Message:
Sent: 09-05-2024 14:16
From: Katie Wehri
Subject: Expansion of Hospice Prepayment Medical Review

This morning's MLN Newsletter included an article announcing the expansion of hospice prepayment review in four states.  The short article, "Hospice Benefit:  Expanding Prepayment Review in 4 States", consists of a few sentences and is not clear on exactly what 'expand' means.  It states:

To combat fraud, waste, and abuse under the hospice benefit, CMS will expand prepayment medical review this September in Arizona, California, Nevada, and Texas. To help reduce burden on compliant providers, initial review volumes will be low and adjusted based on results. 

If you're noncompliant, we may implement extended review or take additional administrative actions.

We have reached out to CMS' Center for Program Integrity (CPI) asking for clarification on which hospice providers are included in the expansion and how the expansion is going to be conducted - new hospice providers as defined in the June 2024 MLN Fact Sheet, all hospice providers or another subset of providers; is there a defined timeframe for the end of the expansion, will it only be the MACs that are conducting the prepayment review, etc.

We will provide an update here as more information is available. 

------------------------------
Katie Wehri
Vice President of Regulatory Affairs, Quality & Compliance
NAHC
Washington, DC
202-240-9254 #3360
------------------------------