What is a False Claims Act investigation?
What is the False Claims Act? The False Claims Act (FCA) was established in 1863 during the Civil War to combat fraud and abuse perpetrated by…
What is the hospice governing body?
What is the governing body? In accordance with the Conditions of Participation, a Medicare certified hospice agency must have a governing body. The governing body has…
What is a UPIC audit?
What is a UPIC? Unified Program Integrity Contractors (UPICs) are contracted by CMS to conduct detailed medical review, data analysis, and audits of healthcare providers to…
What is the TPE audit process?
What is a TPE? A Targeted Probe and Educate (TPE) is an audit program that was rolled out by CMS in 2017. The stated goal of…
What is a SMRC review?
What is a SMRC? A SMRC is a Supplemental Medical Review Contractor. CMS contracts with SMRCs to conduct medical reviews for Medicare Part A, Medicare Part…
What is the Hospice Quality Reporting Program (HQRP)?
What is the purpose of hospice quality reporting? The Affordable Care Act authorized the establishment of a Quality Reporting Program for hospices. The Hospice Quality Reporting…