Hospice Compliance and Oversight

In recent years, concerns surrounding hospice care have drawn significant attention, particularly regarding instances of abuse and inadequate oversight. However, strides towards improving regulation and compliance have been made due to the regulatory changes after the 2019 OIG report and Hospice Act of 2021.

Light was shed on troubling trends within the hospice sector, revealing instances of substandard care, billing irregularities, and cases of fraud and abuse. These findings underscored the urgent need for comprehensive reforms to safeguard the well-being of patients and ensure the integrity of hospice services.

In response, the Hospice Act of 2021 introduced a series of provisions designed to address key areas of concern identified by the OIG reports — Senior Care Solutions can help you remain compliant.

These new requirements include the following:

> Enhanced Regulatory Scrutiny: CMS and state health departments are implementing stricter oversight measures. This includes more frequent inspections, comprehensive audits, and stringent enforcement of compliance standards.

> Quality of Care Requirements: The HQRP program includes HIS measures, CAHPS and newly added Hospice Care Index measuring 10 different quality indicators. Additionally, the HVLDL measures visits in the last 7 days of life by the RN and SW. There could be a 4% reduction in reimbursement for not participating in this quality program.

> Billing Integrity: There are tighter controls on billing and reimbursement processes to combat fraudulent billing practices. Hospice providers are now required to demonstrate the medical necessity of services rendered and adhere to clear guidelines for billing accuracy. Audits and reviews are conducted more rigorously to identify and address instances of improper billing.

> Patient Rights and Protections: The Hospice Act reinforced the rights and protections afforded to hospice patients and their families. It mandated the provision of comprehensive information about available services, treatment options, and end-of-life care planning. Patients are empowered to make informed decisions about their care, and mechanisms for reporting grievances and concerns are strengthened.

While challenges persist, there is an evolution of hospice regulation and oversight changing for compliance purposes and provider excellence. By prioritizing patient safety, quality of care, and billing integrity, there is a new standard for accountability within the hospice industry and reaffirms the commitment to upholding the dignity and rights of those nearing the end of life.

Contact Senior Care Solutions for help with compliance.

Lisa Diez, MA, BSc
Director of Home Care and Hospice Consulting
Senior Care Solutions

Read More:

Skilled Care Reimbursement: Recipe for Reimbursement

Blog Post by Michelle Stober RN, BSN, PHN, CEO Senior Care Solutions — The MDS assessment is your invoice for getting paid and unless you are occasionally checking the coding of your “invoices” you might be losing out on significant revenue.

The Benefits of Mock Surveys in Hospice

Mock surveys rehearse official inspections for hospices, pinpointing areas for improvement before real surveys. This helps staff prepare, identifies weaknesses, and boosts confidence.

Lores Consulting and Senior Care Solutions Proudly Announce their Strategic Partnership!

Senior Care Solutions (SCS) announces a partnership with Lores Consulting, expanding into Home Care and Hospice services. Lores Vlaminck, a retiring expert, joins forces with SCS's Michelle Stober. Both are passionate about quality care and aim to serve a wider client base. SCS is also affiliating with relevant industry groups in Minnesota.

Nursing Home OSHA Ergonomics Program Law Effective 1/01/24

The 2023 Legislative Session passed a law effective January 1st , 2024 stating healthcare entities must have an ergonomics program (healthcare entity includes Nursing Homes).

The Heart of the Holidays: Meals in Assisted Living

Assisted living holiday meals are social events, but food safety is crucial. Staff should prioritize proper hygiene, temperature control, storage, and kitchen checks. Consider adaptations for resident needs while maintaining festive flavors. By following these tips, communities can celebrate safely and spread holiday cheer.

Navigating the Holidays through Grief

The holidays can be tough for those grieving. This blog post offers tips for coping, like acknowledging your feelings, creating new traditions, and setting boundaries. It also suggests honoring your loved one and practicing self-care. Remember, grief is personal, so be kind to yourself.

Five Creative Ideas for Leaders to Help Keep Your Team Engaged

We offer tips for leaders to bring fun into the workplace. Ideas include holding meetings in new locations, having team lunches, taking walks, incorporating fun elements into stand-up meetings, and organizing monthly team-building activities. It emphasizes that having fun boosts morale and shows investment in employees.

How Supplemental Nurses and Caregivers Can Help Your Assisted Living Staffing Plan

This blog post tackles healthcare staffing shortages. It highlights the use of supplemental staffing agencies and offers 3 key tips for facilities: 1) Verify agency accreditation, 2) Ensure staff meet facility requirements, and 3) Conduct thorough agency orientations. These steps help maintain quality care and compliance during staffing shortages.

Is Your Coffee Too Hot?

This blog post warns about the burn risk from hot coffee in healthcare facilities. While coffee should ideally brew at 195°F, safe drinking temperature is much lower (155°F can burn in 1 second!). Lowering brewing temperature sacrifices flavor. The solution is to prevent spills with locked machines, air pots, travel mugs, etc. pen_spark

Latest Updates on the MDH Assisted Living License Survey Trends

This blog post by Julie Dietz, a senior assisted living consultant, summarizes the most common deficiencies found in recent Minnesota assisted living facility inspections.

Get Updated on the 2022 Legislative Changes to the Assisted Living License

This blog by Julie Dietz summarizes changes to Minnesota's assisted living laws. Key changes include updating resident rights regarding privacy and adding contact info for complaint reporting. The assisted living contract must now include termination grounds and the facility ID number.

Reduce Immediate Jeopardy Tags With Appropriate Sling Use

High staff turnover and COVID-19 focus on infection control have led to more regulatory scrutiny in nursing homes. Inappropriate sling use is a growing concern. Facilities should ensure proper sling size, documented plans, staff training, and regular audits to prevent resident injuries.