Hospice Prepayment Review Expansion Notice

Hospice Prepayment Review Expansion Notice

A few days ago, CMS released MLN7215293 September 2024:

Expanded Prepayment Review of Existing Hospices in Arizona, California, Nevada, & Texas. 

Get your own pdf here.

The document doesn't answer every question hospices across the nation are asking. But it does specify that, "This may affect you if you’re an existing hospice provider in the states of Arizona, California, Nevada, or Texas." 

It also says "To help reduce burden on compliant providers, we’re keeping the initial review volumes low and adjusting them based on the results. If you’re noncompliant, we may continue to review or take additional administrative actions." And, that agencies under review will receive a letter that includes both a "notice of the review," and identifies the "claims selected for review." 

Then CMS gives an ominous warning that states "If you don’t respond to our requests, we may deny claims or revoke your Medicare enrollment." And, lest hospices in other states think they're off the hook, it adds the reminder that, "We can conduct medical review to prevent improper payments in other states or as necessary based on aberrant billing behaviors."

For help auditing your records prepayment, contact me. Much better to find and correct errors (when that's possible) than to wait until CMS finds problems.

Be well.
Beth 
Back to blog

Leave a comment