On Friday, the Centers for Medicare and Medicaid Services issued a proposed rule that would give hospice providers a 2.8% reimbursement increase and would institute a number of penalties for hospices that fail to meet reporting requirements. The rule signals a long-expected federal crackdown on hospice fraud, waste and abuse.
According to Modern Healthcare, the proposed rule caps hospice reimbursement at $33,369.55 and the rule in total is expected to provide hospice providers a $720 million pay increase.
Back in March, the Medicare Payment Advisory Committee (MedPAC) recommended a 20% cut to the aggregate cap for hospice payments. Hospice News reports that the committee determined that hospices could handle a pay cut based on margin performance but cap reductions would be more effective.
Instead, the agency will move to codify the Hospice Quality Reporting Program (HQRP) and will hand hospices that fail to meet quality reporting requirements a 1.2% decrease, Inside Health Policy explains.
From the CMS fact sheet:
CMS is looking closely at the hospice industry, as we have increasing concerns about fraud, waste and abuse in this space. While this rule takes initial steps, this is part of a larger effort by CMS to address hospice fraud, waste and abuse that will continue this year.
CMS also included a proposal to require physicians that order hospice to be enrolled in or opt out of Medicare in order to be reimbursed for the recommendation, Axios notes. CMS cited reports from the Office of Inspector General (OIG) that some doctors have improperly recommended hospice care to beneficiaries.
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