Rules and Regulations - Office Team

Patient Privacy, Confidentiality, and HIPAA Regulations

As a member of the hospice healthcare team, you play an important role in caring for your patients. Because of this, you will often learn private information about them – not just about their health, but also about their personal relationships, their financial situations, and other sensitive and per

August 25, 2024 · 3 min read

Hospice Length of stay – active or discharged patients?

Patient length of stay is monitored to detect instances of inappropriate use of the hospice benefit or other deficiencies in the services delivered by the hospice provider. Length of stay is monitored for both very short length of stay as well as for length of stay that is longer than the norm. What

March 22, 2023 · 3 min read

Average length of stay versus median length of stay

Patients are eligible for hospice if they have a terminal diagnosis and a prognosis of six or fewer months to live if their disease runs its natural course.  A patient who lives longer than six months can still get hospice care if the medical director or other hospice physician recertifies that the

March 22, 2023 · 5 min read

What is a False Claims Act investigation?

What is the False Claims Act

January 29, 2023 · 8 min read

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 provided. It is recommended that

November 27, 2022 · 3 min read

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 survey is a component of the Ho

November 27, 2022 · 5 min read

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 improper billing. Hospice agencies

November 26, 2022 · 5 min read

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 Visits When Death is Imminent (HVWD

November 13, 2022 · 4 min read

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 with an added metric to support inf

November 13, 2022 · 4 min read

Medicare Credit Balance Report

What is Medicare credit balance? A Medicare credit balance represents a Medicare overpayment to a provider due to patient billing error or claims processing error that must be refunded to Medicare.  The report is referred to as a Credit Balance Report because when a provider receives excess payment

September 29, 2022 · 3 min read

Untimely NOE: Requesting an Exception

September 20, 2022 · 1 min read

Unusual Circumstances: Face to Face Encounters

Prior to the third hospice benefit period, and prior to each subsequent benefit period, a hospice physician or nurse practitioner is required to have a face to face encounter with the hospice patient to recertify that the patient continues to be Medicare eligible for hospice benefits.  The face to f

August 4, 2022 · 2 min read

What is Face to Face Recertification?

A hospice face to face encounter is a step in patient recertification beginning with the third benefit period and each benefit period thereafter. The goal of hospice face to face patient encounter is to encourage greater involvement of the physician in the care of patients who have been on hospice f

August 4, 2022 · 3 min read