The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy for a Shifting Payment Landscape

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The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy

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The Hospice Guide to Billing and Reimbursement: Durable Guidance and Strategy for a Shifting Payment Landscape

Casey Fenton 
Catherine Stapleton, MS

The industrywide march toward standardized performance measurement and unified value-based payment structures requires hospice agencies to stay on top of CMS regulatory guidance. The Hospice Guide to Billing and Reimbursement is your comprehensive solution to implementing accurate, compliant, and competent billing practices at your organization. This book will help you provide the best training possible to your administrative staff and those who impact billing, increasing their competence and confidence about billing requirements and practices. It will equip providers with the broad frameworks and processes needed to develop billing systems and financial plans that meet CMS’ ever-sharper scrutiny.

This book will help you understand:

  • Regulators’ expectations surrounding billing and reimbursement for the Medicare hospice benefit
  • Recent updates to payment terms, such as the introduction of the Service Intensity Add-on (SIA) and the two-tiered reimbursement structure for the provision of routine homecare
  • What you need to do to prepare for the major changes still ahead (e.g., value-based purchasing models)
  • How not to leave money on the table—or be penalized unnecessarily


Table of Contents: 

  • Today’s Hospice Reimbursement and Billing Landscape at a Glance
    • Overview of the Medicare hospice benefit
    • Foundations of hospice billing and reimbursement
    • Key developments in recent years
      • Trends toward federal scrutiny and enforcement in the sector, including increasing tracking of and crackdowns on fraud and abuse
    • Large-scale changes on the horizon 
  • Linking Hospice Philosophy, Care Practices and Outcomes, Operational Processes, and Received Payment
  • Promoting Ongoing Compliance With Long-Standing Components of Hospice Payment and Billing
    • Honoring patient eligibility requirements 
    • Understanding sequential billing
    • Distributing Medicare coverage notices
    • Creating effective cost reports
    • Responding to additional development requests (ADR)
    • Withstanding audits
  • Adapting Practices and Processes to Accommodate Recent, Industrywide Payment Rate and Process Changes
    • The SIA and two-tiered RHC payment model introduced through 2016 rulemaking
    • Recent adjustment to hospice caps calculation methodology
    • Integrating the hospice PEPPER report (including recently updated coverage areas) into internal billing compliance initiatives 
    • Adhering to quality reporting expectations to avoid payment penalties 
    • Promoting timely filing of election notices and recertifications, as well as timely completion of face-to-face documentation 
    • Curbing high rates of recertification and revocation 
    • Implementing effective compliance strategies surrounding the launch of ICD-10 and general coding-related practices (including clinical documentation) that can influence payment
  • Recognizing and Readying Internal Systems for the Prospective Impact of Continuumwide Payment Reform Initiatives
    • Value-based purchasing
    • Bundled payments
    • Accountable care organizations (ACO)
  • Implementing Enduring Billing Best Practices, Strategies, and Systems to Facilitate the Receipt of Deserved Reimbursement 
    • Complying with setting-specific guidelines, rules, and regulations, especially those governing hospitals, skilled nursing facilities, and assisted living facilities 
    • Developing effective initial and ongoing staff training
      • Compensating for and combatting high turnover rates
      • Using learning modules to jump-start training sessions


About the Authors:

Casey Fenton, and Catherine Stapleton, MS, are directors at Precipio Health Strategies, a Washington, D.C.–based healthcare advisory and consulting firm that specializes in helping providers “create and implement business growth strategies among the changing payer landscape.” 

Published: July 2016