decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Hospice Model Compliance Plan / Using OIG's hospice model compliance program / Utilization of hospice services
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Article Overview
This article discusses hospice compliance planning with emphasis on utilization oversight, interdisciplinary group review, and internal processes for identifying and correcting service-delivery concerns. It is relevant to hospice administrators, compliance staff, and coders who support Medicare hospice operations and want to understand general compliance expectations tied to patient care coordination and resource use.
Why This Topic Matters
Hospices must manage services carefully to support appropriate care delivery and compliance with Medicare hospice requirements. Understanding the article helps organizations evaluate utilization-related risk areas and strengthen internal monitoring and corrective action processes.
Article Sections
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Utilization oversight in hospice care
Introduces the hospice’s responsibility to manage resources and coordinate covered services for beneficiaries electing hospice care. Describes the overall compliance focus on appropriate allocation and service utilization.
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Monitoring and review processes
Covers routine internal review activities used to evaluate service use, staffing, and patient needs. Discusses interdisciplinary case reviews, conferences, and written criteria used in hospice oversight.
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Common utilization concern areas
Summarizes major categories of utilization issues that may signal operational or eligibility concerns. Addresses admission, length of stay, delays in services, and treatment-related issues.
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Corrective and preventive actions
Describes the types of follow-up steps a hospice may take when utilization concerns are identified. Focuses on monitoring, service adjustments, and policy or procedure revisions.
What You Will Learn
- How hospice organizations monitor resource use and service coordination
- Why interdisciplinary review is part of hospice utilization oversight
- What broad categories of utilization concerns may require follow-up
- How corrective and preventive actions fit into hospice compliance efforts
Who Should Read This
- Hospice administrators
- Compliance officers
- Utilization review staff
- Case management and interdisciplinary care teams
- Medical coding and reimbursement professionals supporting hospice services
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