HHS Issues Reminder on Hospice Provider Compliance

The U.S. Department of Health and Human Services (HHS) is reminding hospice providers of specific ways they can improve reporting on election statements. After a stratified random sample review of hospice election statements and certifications of terminal illness, the Office of the Inspector General (OIG) reports that more than one-third of hospice General Inpatient (GIP) stays lacked required information or had other vulnerabilities.

• Hospice election statements did not always mention, as required, that the beneficiary was waiving coverage of certain Medicare services by electing hospice care or that hospice care is palliative rather than curative.
• In 14 percent of GIP stays, the physician did not meet requirements when certifying that the beneficiary was terminally ill and appeared to have limited involvement in determining that the beneficiary’s condition was appropriate for hospice care.

Hospices should improve their election statements and ensure that physicians meet requirements when certifying beneficiaries for hospice care. Resources are linked below.

• Hospices Should Improve Their Election Statements and Certifications of Illness, OIG Report;
• Hospice Payment System Booklet, which includes a section on the hospice election statement;
• Documentation Requirements for the Hospice Physician Certification/Recertification, MLN Matters Article;
• Sample Hospice Election Statement, MLN Matters Special Edition Article.

Contact: Meg Carr Everett, meverett@leadingageny.org, 518-867-8871