The Health Law Partners, P.C. is a unique healthcare law firm, comprised of lawyers who understand the multitude of legal issues facing hospice organizations. With increased auditing activity and Medicare claims scrutiny resulting from the Medicare Recovery Audit Contractor (“RAC”) program, and given the recent changes to the hospice Conditions of Participation (“CoPs”), compliance has never been more important.
Abby Pendleton, Esq. and Jessica Gustafson, Esq. have worked on thousands of post-payment audits and Medicare appeals filed on behalf of hospice entities nationwide and have tackled many of the unique regulatory issues in the hospice field. Common hospice regulatory issues include:
- Technical regulatory issues:
- Certifications and Recertifications
- Election Statements
- Plans of Care
- Issues regarding the hospice eligibility of beneficiaries:
- Increased scrutiny of certain non-cancer diagnoses (e.g., Alzheimer’s disease, Adult Failure to Thrive, Chronic Obstructive Pulmonary Disease (“COPD”), and Congestive Heart Failure (“CHF”)
- Long lengths of stay
Attorneys of The Health Law Partners, P.C. can assist hospices in a broad array of areas, including but not limited to:
- Representing hospices in RAC and other Medicare audits;
- Assisting hospices subject Targeted Medical Review (“TMR”) and other payment edits;
- Assisting with the development of compliance policies;
- Providing compliance in-services and education;
- Providing guidance regarding other regulatory issues;
- Analysis and structuring of relationships for compliance with the fraud and abuse laws;
- Providing guidance regarding employment matters;
- HIPAA; and
- Other healthcare law matters.
The Patient Protection and Affordable Care Act of 2010 (“PPACA”) included important changes to the hospice certification requirements. Pursuant to Section 3132 of PPACA, Section 1814 (a) (7) of the Social Security Act will be amended to require that on and after January 1, 2011, a hospice physician or nurse practitioner must have a face-to-face encounter with every hospice patient to determine continued eligibility of the patient prior to the 180-day recertification and prior to each subsequent certification. PPACA also requires that the hospice physician or NP attest that such visit took place. A Proposed Rule that would serve to implement provisions of PPACA was published on July 23, 2010.
Lawyers from The Health Law Partners, P.C. regularly write and speak to provider associations regarding issues facing hospice providers and Medicare appeals. For example:
"Recovery Audit Contractors and Medicare Audits: Successful Strategies for Defending Audits," co-authored: Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., Caring, National Association of Home Care and Hospice, November 2008
"RAC to the Future: What Can Medicare Providers and Suppliers Expect from the Recovery Audit Contractor Program?" co-authored: Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., The Health Lawyer, The ABA Health Law Section, Vol. 21, No. 2, December 2008
"An Unprecedented Era of Claims Scrutiny: Successfully Managing Targeted Medical Review, Recovery Audit Contractor and Medicaid Integrity Audits," Jessica L. Gustafson, Esq., Nebraska Hospice and Palliative Care Association 2011 Annual Conference, Lincoln, NE.
"How RAC & MIC Audits Will Affect LTC Facilities," Abby Pendleton, Esq. and Jessica L. Gustafson, Esq., 2011 Health Care Association of Michigan (HCAM) Spring Leadership Conference, March 31, 2011.
"How RAC and MIC Audits Will Affect LTC Facilities," Jessica Gustafson, Esq. and Abby Pendleton, Esq.. at the Health Care Association of Michigan (HCAM) and the Michigan Center for Assisted Living (MCAL) 2010 HCAM/MCAL Leadership Conference, March 24, 2010.
"Recovery Audit Contractors and Medicare Audits: Strategies for Successful Appeals," Abby Pendleton, Esq.. and Jessica Gustafson, Esq., at the 2010 Georgia Hospice and Palliative Care Organization Annual Leadership and Clinical Conference, February 25, 2010.
“Recovery Audit Contractors and Medicare Audits,” National Hospice & Palliative Care Organization (NHPCO), October 24, 2008
“The Medicare Appeals Process,” 2008 Annual Meeting of the Michigan Hospice and Palliative Care Organization (MHPCO), 2008
“Recovery Audit Contractors and Medicare Audits,” National Hospice & Palliative Care Organization (NHPCO), November 29, 2007
“The Medicare Appeals Process,” 2007 Annual Meeting of the Michigan Hospice and Palliative Care Organization (MHPCO), 2007
Helpful Hospice Links
Click here to access the OIG Memorandum Report on Questionable Billing for Physician Services for Hospice Beneficiaries.
Click here to access the CMS website providing guidance to hospice providers.
Click here to access the Medicare Hospice Conditions of Participations (CoPs).
Click here to access the Medicare Benefit Policy Manual, which provides guidance regarding the Medicare hospice benefit.
Click here to access the Medicare Claims Processing Manual, which provides guidance regarding Medicare hospice claims.
Click here to access the 2009 OIG Semiannual Report to Congress for October 31, 2008 to March 31, 2009, which provides the OIG's actions in prosecuting fraud and abuse cases, including hospices.
Hospice inquiries can be directed to Abby Pendleton, Esq. or to Jessica L. Gustafson, Esq. at (248) 996-8510 or (212) 734-0128.