The Medicare hospice benefit is, by definition, intended for terminally ill patients with a prognosis of six months or less. But in many cases, it can be difficult to estimate life expectancy, particularly for prolonged illnesses with a less predictable disease trajectory such as dementia (which is one of the fastest-growing primary diagnosis categories for patients enrolling in hospice care). As a result, some hospice patients live beyond their initial six-month prognosis, and end up requiring a much longer length of stay.
Terminally ill Medicare beneficiaries can receive hospice care for an unlimited time—as long as they continue to meet the eligibility criteria. However, it’s important to be aware that long lengths of stays can raise red flags with regulators who have identified them as an area of vulnerability and risk for Medicare fraud.
A 2018 OIG report found that hospices may be incentivized to target beneficiaries requiring longer stays as they offer the greatest financial gain, which “raises questions as to whether hospices are enrolling beneficiaries appropriately.”
What does this mean for you?
A hospice patient whose length of stay (LOS) exceeds 180 days requires more frequent eligibility reviews and more extensive documentation to justify continued eligibility at recertification time. In addition, hospices with a high proportion of longer-stay patients (LOS > 180 days) may be subject to more frequent pre-payment reviews and other types of audits.
Improving your recertification process to ensure compliance is one of the most effective ways you can succeed in a regulatory environment that scrutinizes longer lengths of stay. Failure to meet all deadlines and documentation requirements can lead to denied claims, lost revenue and other repercussions.
To help you stay on top of recertifications for your hospice, we’ve created two practical resources:
– Hospice Recertification Guide: This easy-to-read guide will help your team recertify patients with timely, complete and compliant documentation.
– Stop Hospice Recertification Denials in Their Tracks: This webinar provides more detailed guidance on streamlining your recertification process and reducing denials.
Check them out! Hospice recertifications are a necessary part of hospice care, but they don’t need to be a source of undue stress and frustration.