Hospice: Watch Out for Regulatory and Compliance Hot Spots

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article reviews regulatory and compliance issues affecting hospice providers under a CMS proposed payment rule for 2017. It focuses on high-level policy changes, quality reporting, data trends CMS is monitoring, and the increased likelihood of provider-specific review for hospices whose billing or documentation patterns appear unusual. The piece is aimed at hospice administrators, compliance staff, and coding/billing professionals who need to understand the broader oversight environment without providing coding instructions.

Why This Topic Matters

Hospice organizations operate under close Medicare oversight, and changes to payment policy, quality measurement, and documentation review can affect compliance risk. Understanding what CMS is monitoring helps providers assess their internal processes and prepare for possible medical review or audit activity.

What You Will Learn

  • What CMS is focusing on in hospice payment and oversight policy
  • Why hospice data patterns may attract additional scrutiny
  • How documentation and compliance concerns relate to medical review risk
  • What broad areas of hospice reporting and monitoring are highlighted

Who Should Read This

  • Hospice providers
  • Compliance officers
  • Medical coders
  • Billing staff
  • Revenue cycle teams
  • Healthcare administrators

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