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LeadingAge Joins Calls for Hospice Audit Process Change, Education Support

Push for hospice program integrity continues: joint letter to CMS urges agency to maintain momentum and improve auditor education, auditing process

Continuing its advocacy efforts aiming to improve targeting of hospice program initiatives, LeadingAge, the association of nonprofit providers of aging services including providers of hospice care, joins four other hospice-focused trade organizations in applauding the Centers for Medicare and Medicaid Services’ (CMS) reform work and urging additional action to ensure the success of the agency’s audit focus by appropriately targeting oversight efforts.

In a letter to CMS’ Center for Program Integrity (CPI), LeadingAge, the American Academy of Hospice and Palliative Medicine, the National Association for Home Care & Hospice (NAHC), the National Hospice and Palliative Care Organization (NHPCO) and the National Partnership for Healthcare and Hospice Innovation (NPHI) describe fundamental, long-standing problems that must be addressed including audit focus areas, the overpayment recovery and recoveries adjudication processes, and auditor consistency and education.

“Nonprofit providers of hospice care have long been standard bearers for quality care in the sector, and our mission-driven members are committed to maintaining that leadership role through action,” said Katie Smith Sloan, president and CEO, LeadingAge. “That’s why we urge CMS to continue its strong program integrity initiatives by rectifying long-standing issues with auditing focus and direction, including unclear and mixed messaging that leads to inconsistent auditing outcomes. Education and training must be bolstered so that contractors are equipped to undertake meaningful audits. We share the Administration’s goal of ensuring quality hospice care. To achieve that, the auditing system must be supported and improved.”

In the letter, the organizations propose CMS consider the following:

  • Re-focusing its audit contractors on patterns and practices characteristic of providers that aim to minimize or avoid therapeutic care and supportive services that are required under the hospice benefit and fully reimbursed through the per diem payment.

  • Placing emphasis on the education of providers rather than recovery of payments and ensuring there are clear definitions and standards communicated effectively to hospice providers and are applied uniformly in the audit process.

  • Requiring substantive education and training for all auditors that is consistent with the education given to providers to minimize inconsistencies.

  • Modifying the audit, recovery, and appeals processes to reduce the need for lengthy adjudication and reduce the burden for typically compliant hospice providers. Included in this should be a procedure for centrally monitoring audits across all contractors to ensure a high bar for why a provider must go through multiple audits simultaneously. Additionally, there should be an opportunity for mediation with the MAC to explain the provider’s justification for the billing and correct auditor errors before denial or recovery of claims are initiated.

  • Increasing transparency of CMS contractor activity, including the number and types of audits being conducted, audit recovery amounts, results of audits by specific audit contractors, including reversal rates, and top denial reasons.

“Consistent high quality hospice care throughout the sector can be achieved through commitment and partnership. We look forward to working with CMS on these important matters,” Sloan added.


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