Regulatory

• Electronic Code of Federal Regulations (ECFR) - Hospice Care

• Hospice Wage Index (by fiscal year)

• Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements (by fiscal year)

  • FY2024 Hospice Payment Rate Update Final Rule

• ASPR Administration for Strategic Preparedness & Response

• Proposed House of Representatives Bill H.R. 9803 Hospice CARE Act of 2024

• Proposed House of Representatives Bill H.R. 10097 Enhancing Hospice Oversight and Transparency Act

• Manage Provider Enrollment via Provider Enrollment, Chain, & Ownership System (PECOS)

• OIG / Office of the Inspector General

  • General Compliance Program Guidance November 2023

  • Compliance Program for Hospice (Electronic Federal Register)

  • 2022 Top Unimplemented Recommendations

  • Excluded Persons Database

  • Active Work Plan

  • Hospice Deficiencies Pose Risks to Medicare Beneficiaries

  • Medicare Improperly Paid Acute-Care Hospitals an Estimated $190 Million Over 5 Years for Outpatient Services Provided to Hospice Enrollees

  • Medicare Paid Millions More for Physician Services at Higher Nonfacility Rates Rather Than at Lower Facility Rates While Enrollees Were Inpatients of  Facilities

  • Medicare Payments of $6.6 Billion to Nonhospice Providers ... Suggest the Need for Increase Oversight

  • Nationwide Review of Hospice Eligibility

• 21st Century Cures Act - 7 Elements of a Compliance Program

• 2017 Measuring Compliance Program Effectiveness Resource

• 2019 DOJ Evaluation of Corporate Compliance Program Resource Guide

• Gap Billing Between Hospice Transfers (Change Request MM12619)

• Guidance on Immediate Jeopardy

• Medicare Benefit Policy Manual – Chapter 9, Coverage of Hospice Services Under Hospital Insurance

• Medicare Claims Processing Manual – Chapter 11, Processing Hospice Claims

• Medicare Program Integrity Manual – Chapter 3, Verifying Potential Errors and Taking Corrective Actions

• MedPac Report to Congress 2022 (see Chapter 11, page 323 for Hospice)

• State Operations Manual

  • Appendix M - Guidance to Surveyors / Hospice

  • Appendix Z - Emergency Preparedness​

​

CMS Forms & Tools

• Model Example of Hospice Election Statement (scroll to downloads section)

• Patient Notification of Hospice Non-Covered Items, Services and Drugs (The Addendum)​

• • Frequently Asked Questions

• Advance Beneficiary Notification Notice of Non-Coverage (ABN) (scroll to downloads section)​​​

  • ABN Flow Sheet​

• ​Notice of Medicare Non-Coverage (NOMNC)

• Detailed Explanation of Non-Coverage (DENC)

  • DENC Flow Sheet

• Beneficiaries Notices Initiative (BNI) Downloads and Instructions​

• Look-up Tool for Provider Status

  

Audit Information

• Audit Response Information Checklist from Weatherbee Resources

• MAC Audit Tool (Pre-billing) - CGS

• MAC Audit Tool (Pre-billing) - NGS

• MAC Audit Tool (Pre-billing) - Palmetto GIP

• TPE Information Sheet

  • TPE Q&A Sheet

  • CMS Manual Change Request 10249 – TPE (Released September 25, 2017)

• CMS Medicare Appeals Process Information & Forms

  • First Level of Appeal: Redetermination by a Medicare Administrative Contractor (MAC)​

  • Second Level of Appeal: Reconsideration by a Qualified Independent Contractor (QIC)​

  • Third Level of Appeal: ALJ Hearing with the Office of Medicare Hearings and Appeals (OMHA)​

  • Fourth Level of Appeal: Review by Medicare Appeals Council

  • Fifth Level of Appeal: Judicial Review in Federal District Court

​

Billing

• CGS

  • ​Billing Hospice Physician and Nurse Practitioner and PA Services Flow Sheet from CGS

  • Hospice Medicare Billing Codes Sheet from CGS

• NGS

  • Physician and Nurse Practitioner Billing from NGS

• Palmetto

  • Billing Hospice Physician, Nurse Practitioner (NP) and Physician Assistant (PA) Services from Palmetto

• CPT® Evaluation and Management (E/M) Code and Guideline Changes from AMA

• E&M Visit Coding Tool 2023 from Acevedo Consulting, Inc.

• Dementia ICD10 Code Update Tool FY2023 from Acevedo Consulting, Inc.

• Level of Medical Decision Making (MDM)

 

Program for Evaluating Payment Patterns Electronic Report (PEPPER)

• PEPPER Resources Portal

• PEPPER Checklist

​

Quality And Performance Improvement (QAPI)

• Hospice Quality Reporting (HQRP)

• Hospice Item Set (HIS)

• Hospice Visits in the Last Days of Life (HVLDL) and Hospice Care Index (HCI) Measures

• CAHPS® (Consumer Assessment of Healthcare Providers and Systems) Hospice Survey

• Care Compare Website

  • How to Update Hospice Demographics on Care Compare Website

• CAHPS® Hospice Survey Care Compare Data Refresh Schedule

• Performance Improvement Project (PIP) Guidance and Template Tool​​

​

Assessment Scales

• ECOG (Eastern Cooperative Oncology Group)

  • Abstract​

• FAST (Functional Assessment Staging)

  • Abstract​

  • Video "To FAST or Not to FAST" and use of FAST for Alzheimer's Disease only

• ICF (International Classification of Functioning, Disability, and Health)

  • ICF in Detail and More Information​

• KPS (Karnofsky Performance Scale)

  • Abstract​

• NYHA (New York Heart Association) Classification System

  • Abstract​

• PPS (Palliative Performance Scale)

  • Abstract​

• Disease Trajectories

• Time-To-Task ADL Completion Tool

• Mid-arm Circumference ... How to Measure Properly

  • Poster for download with video QR code​

  • Video

​

Local Coverage Determinations (LCDs)

• LCDs for All Contractors

  • Select a Report dropdown menu

  • Scroll to Local Coverage Final LCDs by ... contractor, state, or alphabetical

• CMS Medicare Administrative Contractor (MAC) Map

​

​Miscellaneous​

• ​Common Hospice Acronyms

• Dementia is a surrogate for frailty in hip fracture mortality prediction
  (European Journal of Trauma and Emergency Surgery, 2022)

• Persistence of Excess Mortality Following Individual Nonhip Fractures: A Relative Survival Analysis
  (The Journal of Clinical Endocrinology and Metabolism)

• HMDCB / Hospice Medical Director Certification Board

  • Certification Exam Resources​

• Illness Trajectories and Palliative Care (BMJ 2005)

• National Alliance for Care at Home Facts & Figures 2024 Edition

• NHPCO Facts & Figures 2023 Pediatric Edition

• Post-Boot Camp Checklist

• Relatedness Algorithm - Relatedness to the Terminal Prognosis Process from NHPCO

• Relatedness Algorithm - Determination of Hospice Medication Coverage from NHPCO

​

Public Health Emergencies CMS

• Current Emergencies

• Health and Human Services (HHS) ASPR-TRACIE Resource for Disaster Preparedness/Emergency Planning

​

Weatherbee Resources Education & Products​

• All Education Events

• Providers / Physician and Nurse Practitioner Education and Tips Webpage

• LCD Pocket Pal

• Read about the Hospice Compliance Network / HCN!   ...   $1,000 special first year offer!

• All Products including Hospice Contracts and Hospice Policies & Procedures!

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From Our Partners

• CAHPS Scores Whitepaper (from Qualis)

• Deprescribing Tips (from AvaCare)

 

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