129: Hospice Under the Microscope: Are You Ready for the Audit?

SPEAKER_1 (0:02)

You're listening to Home Health Revealed, where the business of home health comes to life. Hosted by Hannah Vale, each episode brings real conversations with the leaders, innovators and experts shaping the future of the industry. From reimbursement and technology, to leadership and growth, this is Home Health Revealed.

Hannah Vale (0:17)

All right, let's go. This is sort of a part two because we just did a recording really recently on palliative care and how that's going to be impacted hopefully by the proposed rule.

And now we're going to talk about hospice, focus a little bit on hospice, put the spotlight there and kind of what we're seeing. So again, I have with me Annette Lee of Provider Insights. So glad you're back.

SPEAKER_1 (0:44)

Welcome.

Hannah Vale (0:46)

And I want to just kind of jump right in. I feel like the audience knows who you are. And if not, if this is your first podcast, pause, go back to the one previous, take a listen, get to know Annette a little bit, think about some palliative care and kind of that middle child syndrome that it's going through of like, am I hospice? Am I home health? How can I be my own person in this world?

So with that, we'll jump in. Hospices right now are facing audits from multiple fronts. Annette, what trends are you seeing? And why is audit readiness no longer something agencies can treat as an occasional project?

Annette Lee (1:31)

Right. It used to be so occasional and almost non-existent for years. So I just a quick sidebar. First of all, I had to laugh when you're talking about the middle child of palliative care. I was cracking up, and all I can think of, for those that are old enough to remember, is the Brady Bunch and Jan saying, oh, my nose.

No, that was Marsha, wasn't it? But it was the whole middle thing with Jan. And yeah, if she and our middle child of palliative care really is going through an identity crisis. And I feel like hospice has tried to fill that gap because there is a true like chronic palliative care benefit that really takes care of people's needs. So because I think partly of us filling that gap, CMS has turned that spotlight completely to hospice, I feel now.

It used to be home health. I've done home health and hospice for 35 years. And for the first, I don't know, 20 some of it, it was always about home health and home health having compliance issues and questions and documentation issues. And when I worked for the MAC, in fact, CMS came to us and they wanted data. We were to look at medical review for home health, hospice, and SNF. And at the time, we weren't reviewing any hospice at all. And CMS was like, tell us about what's going in hospice. And we're like, we don't review hospice. And they're like, this is part of your contract. And we basically said, they take care of dying people. We don't have a concern there. And they said, but it's growing. And this was circa like 2000 And they said, it's growing, and we need to start looking at it at least. And wow, what a whirlwind 26 years later to go from no looking at hospice to I feel like most of the looking is at hospice right now.

And so yeah, Hannah, you're right. You can't be thinking that an audit is just, you know, someone else's issue. It's not a matter of if I have an audit, it's when for a hospice. You have to know that this is a multi-tiered approach. CMS is telling the MACs to look at hospice. CMS has multiple post-pay contractors looking at hospice. So the hospice has been paid, it's water under the bridge. We think it's all taken care of, everything's good. And then we get letters requesting multiple charts. For people from two years ago, sometimes. And so that is an operational nightmare, because sometimes we've changed DMRs, or obviously our staff has changed. And so it's hard to ensure we have everything we need from that standpoint. And so I think this is the time again, especially as everyone has kind of known to say, let's press pause a little bit. This is the time to really refine processes, be proactive, look at what we're doing, just make sure that we don't have to be just reactive in a situation like that, but to really take that time and put things in place so we can be more proactive and be ready. Because to your original question, sorry for the long wait.

Hannah Vale (4:55)

No, it's good.

Annette Lee (4:56)