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 investigate possibilities of Medicare or Medicaid fraud, waste, and abuse. While the primary...
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 this program is to help providers reduce claim denials and appeals. The TPE works to achieve its goal by educating providers in topics that...
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 B, and DME providers. SMRCs are contracted through the Center for Program Integrity/Provider Compliance Group...
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 Program (HQRP) was established in 2014. HQRP aims to ensure that the level of...
What is Hospice Item Set (HIS)?
All Medicare certified hospice agencies must submit an HIS Admission and HIS Discharge record on all admissions and discharges from their agency. The report must include all patients, irrespective of payer source, patient age, or location where hospice services were...
What is the CAHPS survey?
The CAHPS survey is intended to measure the experience of patients who had died while receiving hospice care and the experience of their primary caregivers. It surveys informal caregivers – usually family members – of the persons who died under hospice care. The...
What is a hospice PEPPER report?
Program for Evaluating Payment Patterns Electronic Reports (PEPPER) is a data analysis report that has been available for hospices since 2012. This report contains claims data statistics based upon UB-04 claims data submissions for a single hospice agency. The...
Understanding the PEPPER Report
The PEPPER report target areas focus on statistics that will identify potential for improper Medicare billing. Comparison to national, jurisdictional, and state percentiles can highlight a hospice agency’s potential need for change to its practices to guard against...
What is Hospice Visits in the Last Days of Life (HVLDL)?
HVLDL is an HQRP claims-based measure of the proportion of patients who have received in-person visits from a registered nurse (RN) or a medical social worker (MSW) on at least two of the final three days of life. This metric replaces the HIS-based measure Hospice...
What is Hospice Care Index (HCI)?
HCI is a single comprehensive metric reflecting ten indicators of care delivered during a hospice stay -- from admission to discharge. This metric, which is included in the patient Care Compare portal, is intended to provide patients, families, and caregivers...