decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Hospice Model Compliance Plan / Using OIG's hospice model compliance program / Eligibility Requirements
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Article Overview
This article discusses hospice compliance planning with an emphasis on Medicare eligibility requirements, documentation practices, and billing integrity. It explains the kinds of policies and procedures hospice organizations are expected to maintain, the documentation categories that should support reimbursement, and the broader oversight context involving OIG audits and enforcement activity. The article is relevant to hospice administrators, compliance staff, billing personnel, clinicians, and anyone responsible for maintaining Medicare hospice reimbursement support.
Why This Topic Matters
Hospice reimbursement is closely tied to eligibility documentation and accurate claim support, making compliance failures a frequent audit and enforcement risk. Understanding the article helps providers align internal policies with federal expectations and reduce exposure in billing, recordkeeping, and eligibility review.
Article Sections
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Eligibility Requirements
Discusses hospice Medicare eligibility compliance and the documentation and recordkeeping expectations tied to reimbursement. It also addresses how organizational policies should support communication between clinical and billing staff.
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Billing and documentation policies
Covers general billing policy expectations, coding alignment with the medical record, and the need for internal procedures that support accurate reimbursement review. The section also references organizational standards and oversight of personnel practices.
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OIG audits and enforcement activity
Summarizes the broader oversight environment and the types of OIG activities that have focused on hospice compliance issues. It references public OIG materials and enforcement initiatives related to hospice program integrity.
What You Will Learn
- What hospice compliance policies should address in relation to Medicare eligibility
- What categories of documentation should be maintained in a hospice clinical record
- How hospice billing and clinical documentation expectations are described in a compliance context
- What kinds of oversight and enforcement efforts have targeted hospice program integrity
Who Should Read This
- Hospice compliance officers
- Hospice administrators
- Billing department staff
- Clinical documentation staff
- Physicians involved in hospice certification and care planning
- Health care auditors and consultants
Codes Discussed
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