decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Operation Restore Trust / ORT Targets and Actions / Hospices
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Article Overview
This premium article covers CMS-directed hospice oversight within Operation Restore Trust, with emphasis on how regional intermediaries were instructed to identify and review claims patterns that appeared unusual. It is relevant to compliance staff, auditors, hospice billing teams, and healthcare organizations monitoring fraud enforcement activity. The article provides a high-level discussion of the oversight focus, the categories of claim patterns under scrutiny, and the related review context.
Why This Topic Matters
It helps readers understand the compliance and audit environment surrounding hospice services and why certain billing or certification patterns could draw focused medical review.
What You Will Learn
- The role of CMS-directed intermediary review in hospice oversight
- The general claim and certification patterns that triggered focused review
- How Operation Restore Trust related to hospice fraud enforcement activity
- Why hospice providers were included in targeted oversight efforts
Who Should Read This
- Hospice providers
- Medical coders
- Billing and compliance staff
- Healthcare auditors
- Fraud and abuse compliance professionals
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