The top problem hospice billing departments face today is compliance in the midst of CMS’ changing reimbursement landscape, says Casey Fenton, a director at Precipio Health Strategies and co-author of The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy for a Shifting Payment Landscape, recently published by HCPro.
Hospice billing saw quite a few changes this year, and although big changes aren’t expected for 2017, “we are still seeing several hospices that are struggling to provide sufficient detailed information for claims to be accepted. Adding further strain to this situation are MACs’ increased scrutiny over hospices’ billing, which has led to an increase in denied claims,” Fenton says.
This scrutiny—which is unlikely to subside in the next few years—combined with CMS billing and reimbursement changes, will make it difficult for hospices that don’t have an air-tight compliance plan.
Adding to the regulatory challenges are high turnover among hospice administration and the front-office staff who file claims. That high turnover is a main source of error in billing compliance, according to Fenton. “Personnel in these positions are often placed under considerable pressure to file claims, often with little training or coordination from upper management, or practitioners whose comments and signatures might be necessary. This, combined with the strain of working in a hospice setting, can often create an environment prone to employee dissatisfaction or instability.”
To help slow the revolving door in administration and billing, management should adequately train new staff in all procedures and processes related to billing compliance; fostering an environment of cooperation and collaboration will also help retain staff and will lead to more approved claims, she adds.
“In the past several years there has been a considerable uptick in the number of Medicare beneficiaries who use hospice care—a trend that we expect to continue,” she says.
“One of the biggest trends we are seeing in the utilization of the hospice benefit is the movement toward hospice care in the home. The fact that patients prefer home hospice care, and that Medicare supports home hospice care as a way to cut down on inpatient expenses, further encourages our belief that home hospice services will continue to advance and be utilized.”