Major Compliance Risks for Hospices

Patient eligibility, general inpatient and continuing care claims, improper revocation, regulatory requirements, and hospice care in nursing homes are five major areas of compliance risk for hospices, according to an article in the May 2012 issue of Home Healthcare Nurse. The article discusses each area of risk and ways to assess performance for each. It is the second article in a two-part series (see the February 22, 2012, HRC Alerts for information about the first article). To be eligible for the hospice Medicare benefit, patients must be certified as having a terminal prognosis with a life expectancy of six months or less, if the illness runs its normal course; hospices must ensure clear documentation of patient eligibility. Medicare pays much more for general inpatient and continuous care than routine home care; hospices with high rates of general inpatient or continuous care may draw suspicion.