Rules, regulations, requirements, documentation. Sometimes it feels like the list never ends! The Centers for Medicare & Medicaid Services (CMS) recently indicated that changes may be coming to reduce regulatory burden for healthcare providers. At the same time, a recent Office of Inspector General (OIG) audit identified concerns related to hospice eligibility and Medicare payments. When it comes to hospice oversight and compliance, where is the balance?
CMS submitted a proposed rule for review that aims to modernize Medicare and Medicaid Conditions of Participation, Conditions for Coverage, and other requirements. According to a recent Hospice News article, CMS is looking at regulations it considers obsolete, outdated, or excessively burdensome. The goal is to reduce burden, increase flexibility, and allow healthcare providers to direct more resources toward patient care.
Sounds good, right? Maybe, but we don’t know all the details yet. At the time of the report, CMS had not released the complete text of the proposal. CMS had also not identified the specific regulations it might eliminate or change.
Now, let’s look at the other side of the coin.
A recent McKnight’s Home Care article reported on an OIG audit examining Medicare payments for certain new hospice enrollees during fiscal year 2021. OIG reviewed 100 initial certification periods and found that documentation for 45 did not meet Medicare hospice requirements. In 21 periods, the clinical information did not support that the enrollee had a terminal illness. In another 24 periods, the medical records did not meet hospice eligibility documentation requirements.
Based on its sample, OIG estimated that Medicare could have saved $255.1 million in hospice claim payments with additional eligibility review procedures for the group studied. OIG recommended that CMS work with Medicare Administrative Contractors to consider this area in hospice eligibility reviews. CMS agreed with the recommendation.
So, on one hand, we have efforts to reduce regulatory burden. On the other, we have findings pointing to a need for continued oversight. Hospice oversight and compliance may be a balancing act, but reducing unnecessary requirements does not make good documentation and appropriate eligibility determinations any less important.
What does this mean for senior living communities? We may not be the hospice provider, but we certainly work alongside hospice providers every day. Do we understand why a resident has a hospice referral? Is the resident experiencing changes that staff should communicate? Are we documenting those changes? And are we working with hospice providers to support communication among the resident, family, community staff, and healthcare providers?
It may also be a good time to look at the hospice providers serving your residents. Communication, documentation, collaboration, and appropriate care coordination matter. Ask questions when something doesn’t seem right and make sure everyone understands their role.
Regulations may change, and some requirements may eventually go away. However, our responsibility to pay attention to the care our residents receive does not. Maybe less paperwork is coming, maybe not. Either way, good documentation and good communication never go out of style!
Stay well and stay informed!
