Guidance for HOPE Tool Access for Transmissions

Today, we’ll be addressing updates to the Hospice Quality Reporting Program. A newly released 5-part video series is now available to support training on the HOPE tool. The first of the five-part series offers an introduction and general overview of HOPE.

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2026 Hospice Final Rule Released

The 2026 Hospice Final Payment and Regulatory Update Rule was published on August 1 and aligns closely with what was outlined in the proposed version, confirming anticipated provisions and updates.

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Understanding Updates to the Hospice Quality Reporting Program

Today, we’ll be addressing updates to the Hospice Quality Reporting Program. A newly released 5-part video series is now available to support training on the HOPE tool. The first of the five-part series offers an introduction and general overview of HOPE.

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Hospice Trends to Watch: What CMS Monitoring Data Reveals

A recent report on Hospice Monitoring by CMS presented statistics that provide a clear view of current trends and may highlight key areas for evaluation within your organization. The data is compelling and serves as a valuable resource for understanding how hospice agencies are performing across various metrics.

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Understanding a Notice of Medicare Non-Coverage Update that Agencies Overlooked

An important topic needs to be addressed that seems to have been overlooked by some agencies related to the recent update to the Notice of Medicare Non-Coverage, which took effect on January 1, 2025. We previously shared a Monday Minute discussing the new requirement that Medicare Advantage patients must now receive the same Notice of Medicare Non-Coverage form as traditional Medicare patients. This includes the BFCC-QIO information.

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Preparing for HOPE: Key Updates to Guidance Manual Ahead of the October 1 Implementation

In the last week of April, a new version of the Guidance Manual for completing the HOPE tool was released, along with an updated version of the HOPE itself. That manual includes several updates, a few of which I’ll be sharing with you today.

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Reviewing Updated Information on the CAHPS Hospice Survey

In a previous Monday Minute, we reviewed significant changes to the CAHPS Hospice Survey. In that Minute, we mentioned that we would be sharing additional details as we got closer to the implementation phase. Today, we are providing the latest updates on the survey.

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Understanding the Difference between Conditions of Participation and Conditions of Payment

The difference between the Conditions and Participation and the Conditions of Payment is a crucial topic, and a critical issue regarding the distinction between the two needs to be addressed. When discussing the Conditions of Participation, it’s well understood that compliance with CoPs is essential. Whether in home health or hospice, surveyors carefully review these conditions during their surveys.

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Reviewing Significant Changes to the CAHPS Hospice Survey Set to Take Effect on April 1

Major updates to the CAHPS Hospice survey, which were outlined in the Hospice Final Rule released August 2024, will take effect April 1, 2025. Related documents for the CAHPS survey changes are dated online January 2025. It’s essential to confirm that your CAHPS vendor is ready to implement the new processes and forms by April 1.

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2024 Hospice Year in Review and Looking Forward to 2025

As we close out 2024, Hospice has had a roller coaster ride for sure during this year and that will continue into 2025.

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New Regulation Requiring Notice of Medicare Non-Coverage to Include BFCC-QIO Information

A new regulation has been released regarding Medicare Advantage plans. If you are providing home health services to a patient enrolled in a Medicare Advantage plan, you are now required to issue the Notice of Medicare Non-Coverage. This notice must include information about the BFCC-QIO, allowing patients the opportunity to appeal decisions related to their discharge.

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Selections for Hospice Special Focus Program to Take Place in November

The Hospice Special Focus Program, which was finalized about a year ago, will select the list of participating hospices taking place in the program in November of 2024. During the selection process, from the group identified as the bottom 10% of performers—those with the highest scores, which indicate poorer performance—a list will be published on the Special Focus Program website.

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Expanded Pre-Payment Announced in Four States

In a recent update regarding Hospice services, it was announced that the extension of prepayment reviews will occur in four states. This initiative is part of what’s being referred to as Expanded Targeted Probe and Educate.

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Reviewing Important HOPE Tool Information in the 2025 Hospice Final Rule

The Hospice Outcomes and Patient Evaluation Tool, or HOPE Tool, is a clinical assessment tool that will completely replace the HIS, and will be mandatory for all patients, regardless of their payer or age. The HOPE Tool has been in development for quite some time and, although it was finalized in the 2025 rule, it won’t officially take effect until October 1, 2025.

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PECOS Requirement Update Outlined in FAQ Document Released by CMS

The Centers for Medicare & Medicaid Services (CMS) released a Frequently Asked Questions (FAQ) document regarding the PECOS enrollment requirement for certifying Hospice physicians, effective June 3. This document clarified important details that must be understood about your claims processing.

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BFCC-QIO Changes that could Impact Medical Review

The BFCC-QIO, an organization that patients and caregivers can turn to for filing complaints or expressing concerns about the care or information they’ve received from a provider, is set to undergo changes.

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New Draft Legislation Released Could Affect Hospice Payment and Integrity Programs

On June 13, a congressman from Oregon released a comprehensive draft addressing changes in hospice payment and integrity programs. This proposed legislation has the potential to significantly affect hospices nationwide.

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Understanding the Two Hospice Quality Reporting Program Requirements Hospices Must Comply with to Avoid Payment Reductions

In order to avoid a 4% reduction in your upcoming annual payment update, it is essential that hospices are compliant with the Hospice Quality Reporting Program. These Hospice Quality Reporting Program requirements have been established for a while, yet every summer, many hospices across the nation are unexpectedly finding themselves non-compliant with specific aspects of these requirements.

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Deadline Extended for Physician Enrollment in PECOS System

CMS announced on Friday, April 26, that the deadline for PECOS enrollment for attending and certifying physicians in hospice has been extended. Initially, the 2024 Hospice Final Rule stipulated that by May 1, 2024, all attending and certifying physicians, including MDs, DOs, and DPMs, needed to be registered in PECOS or be opted out.

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Understanding the Proposed Adjustments to CAHPS Hospice Surveys

CAHPS Hospice Surveys have been a longstanding component of the hospice program. These surveys have presented challenges for hospices, not only in terms of their content but also in securing the responses needed to make an impact on outcome measures. In the 2025 Hospice Proposed Rule, many proposed adjustments to CAHPS Hospice Surveys are on the table.

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Understanding the Top Two Reasons for Hospice Medical Review Denials

In today’s Monday Minute, Melinda discusses two of the most crucial causes for denial in hospice medical review and outlines proactive measures to avoid them. An increase in denials is occurring due to two very important hospice medical review topics – the Face-to-Face Encounter and the Certificate of Terminal Illness.

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Recent Edit is Blocking Home Health and Hospice Claims from Being Paid

A recent edit is blocking home health and hospice claims from being paid at Palmetto GBA, and possibly at NGS and CGS as well. The edit, which begins with the number “5” and the letter “Z”, is not only stopping payment but is also changing the bill type to a 320 for home health.

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3 Ways to Avoid Hospice Election Statement Denials

Numerous hospice agencies are dealing with denials due to a prevalent medical review issue, specifically related to the Hospice Election Statement.
The Election Statement was updated in October 2020, emphasizing the inclusion of three specific components.

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Hospice Clarifications for Marriage & Family Therapists and Mental Health Counselors

In the Hospice Final Rule last year, a change was made to the Conditions of Participation for hospices that states they could now have family therapists and mental health counselors as part of their Interdisciplinary Group (IDG). However, understand that it is not required for hospices to hire marriage and family therapists, or mental health counselors.

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Preparing for the Hospice Special Focus Program Selection Process

As a response to the Consolidated Appropriations Act of 2021, the Hospice Special Focus Program was created to identify hospices who have poor quality outcomes based on quality indicators. A technical expert panel collaborated with CMS to establish the most effective approach for conducting the Special Focus Program and its content.

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Hospice Preview Reports Available for Review and Reporting

In mid-November, Hospice Preview Reports were released containing information about your Hospice. The information in these reports will be made available as part of the February 2024 refresh of the Care Compare website. Between November 15 and December 15, you’ll have the opportunity to thoroughly review the Preview Reports and report any discrepancies or issues you find in your data.

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2024 Value-Based Insurance Design (VBID) Model Update

Under the VBID model, hospices are subject to the activity involved in the demonstration when a patient is enrolled in one of the participating benefit plan packages. In September 2023, the VBID demonstration participation list was updated, as it is every September, for the period of January through December of 2024.

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Hospice Physicians Required to be in PECOS System 2024

In this week’s Monday Minute, we discuss the requirement of physicians to be registered in the PECOS system.

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Addressing Recent Updates to the Hospice Quality Reporting Program

In this week’s Monday Minute, we address the latest release to the Hospice Provider Preview Reports of the Hospice Quality Reporting Program. Additionally, we will be discussing the significant 4% payment reduction that will be imposed if the HQRP requirements are not met.

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Reviewing the 2024 Hospice Final Rule

In this week’s Monday Minute, we discuss the 2024 Hospice Final Rule that was released July 2023.

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Reviewing New Oversight Measures in Hospice Care

In this week’s Monday Minute, we are focusing on the latest changes to Hospice integrity in fours states and SRMC medical review project.

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Understanding the Implications for Hospice in the OIG’s 2023 Work Plan

In this Monday Minute, we discuss an update to the OIG work plan surrounding General Inpatient Care (GIP).

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Hospice May 2023 Refresh to Care Compare (VIDEO)

In today’s Monday Minute, we discuss the most recent update to Care Compare with the Hospice Quality Reporting Program outcomes.

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Telehealth Clarification at the End of the Public Health Emergency for Home Health and Hospice (VIDEO)

In this Monday Minute, we discuss the official end of the Public Health Emergency on May 11, 2023, causing many of the 1135 waivers to be discontinued on the same day.

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First Look at Updated Hospice PEPPER Reports and Proposed Rule 2024 (VIDEO)

In this week’s Monday Minute, we discuss the recent updates in the Hospice PEPPER Reports and take a look at the Proposed Rule 2024.

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Waivers Ending for Hospice Agencies as the Public Health Emergency is Terminated (VIDEO)

In this Monday Minute, we will talk about the waivers ending for hospice agencies as the Public Health Emergency ends.

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Impact of December 2022 CAHPS Hospice Survey Update (VIDEO)

In this week’s Monday Minute, we talk about the December 2022 CAHPS Hospice Survey update.

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2023 Update on the VBID Model’s Hospice Component (VIDEO)

In this Monday Minute, we discuss the recent 2023 information related to the Hospice component of the Value-Based Insurance Design (VBID) Model.

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Hospice New Rates 2023, ICD-10 Codes Updated & PDGM Proposed (VIDEO)

In this Monday Minute, we discuss the many changes that have gone into effect beginning on October 1, 2022 for Hospice and Home Health.

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Two Important Updates for Outcome Measures and Data Reporting for Hospice (VIDEO)

This Minute will highlight two important outcome measures and data reporting that will be incorporated into the Care Compare site for Hospice.

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Targeted Probe and Educate 101: What You Need to Know (VIDEO)

Targeted Probe and Educate is a major issue that makes Home Health and Hospice agencies anxious. This video covers the process of Targeted Probe and Educate, what happens when you fail a review, and how to prevent it.

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2023 Hospice Final Payment Rule (VIDEO)

This session will review the key highlights from the 2023 Hospice Final Rule. Payment rates have increased, the Hospice Cap is set and the HOPE is looking for Beta testers. Don’t miss it!

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CAHPS Hospice Survey Impact (VIDEO)

This Minute will discuss thoughts surrounding the impact that field staff have on the results of the CAHPS Hospice Survey.

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Detail Review of Hospice PEPPER Content (VIDEO)

This Minute will review some of the detail content of the Hospice PEPPER, specifically the newly added PEPPER targets.

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Hospice Targeted Probe & Educate Update (VIDEO)

This Minute will review some of the current activity with hospice scrutiny in Targeted Probe & Educate. We have seen a huge influx of medical review focused specifically on hospice, which includes Targeted Probe and Educate, since September 2021.

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Diagnosis Coding Update for April 1, 2022 (VIDEO)

This Monday Minute will briefly review the new ICD-10 Diagnoses related to COVID Vaccinations.

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2023 Hospice Proposed Rule Recap (VIDEO)

This Monday Minute will begin unfolding the important content of the Hospice Proposed Rule for 2023.

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Hospice Certificate of Terminal Illness (VIDEO)

This Monday Minute reviews the requirement of the certifying physician to create a clinical narrative, specific to the patient, as a part of hospice certification.

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Home Health & Hospice Quality Reporting Programs (VIDEO)

This Monday Minute will review the reality that the Home Health and Hospice Quality Reporting Program requirements were reinstated with penalties as of July 1, 2020. We will review the deadlines, what is included in those, and the penalties that will be assessed if you are not compliant.

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Local Coverage Determinations (LCD) (VIDEO)

This Monday Minute reminds home health and hospice about the significance that the LCD can have in the medical review of Medicare charts. We want to remind you about a very important document that the Medicare MACs have developed to help assist agencies in understanding the expectation of your medical record documentation.

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Targeted Probe & Educate: Here We Go Again! (VIDEO)

This Minute will take you through a quick recap of the Targeted Probe & Educate framework as the program is being reinstated!

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Emergency Preparedness UPDATE Blog

The Center for Clinical Standards and Quality/Quality, Safety & Oversight Group updated guidance for surveyors in QSO-21-15-ALL which revised emergency preparedness considering the Public Health Emergency (PHE). Emergency Preparedness (EP) takes a front seat with the Pandemic – CMS has revised the EP condition to add elements related to the Public Health Emergency (PHE) and the Pandemic.

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FY2022 Hospice Proposed Payment Rule

In addition to the proposed changes for hospice providers CMS included proposed changes to the Home Health Quality Reporting program (HH QRP) to resume in the reporting for January 2022. The proposed rule for hospice and home health QRP is summarized in today’s blog.

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2022 Hospice Proposed Rule (VIDEO)

Welcome to Monday Minute with Melinda! This video clip gives you some highlights of the just issued proposed rule and resources for obtaining details. Make sure to stay tuned!

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COVID-19 Coding Changes

It remains challenging to code COVID-19 for patients, as there are so many variations seen, especially as time goes on.   However, as of January 1, 2021, we have new diagnosis codes that are to be used for COVID-19 patients. They don’t include all of the patient scenarios for the conditions seen after COVID but it is a start.

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COVID-19 Vaccine Administration (VIDEO)

Welcome to Monday Minute with Melinda! This week’s video clip will discuss the billing and reimbursement for COVID-19 Vaccine Administration. Make sure to stay tuned!

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OIG Conducting Audit on Telehealth (VIDEO)

Welcome to Monday Minute with Melinda! This video clip will recap some of the documentation requirements for telehealth and the OIG audit to take place. Make sure to stay tuned!

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Hospice ADRs on the Rise! (VIDEO)

Welcome to Monday Minute with Melinda! This week’s video clip will provide some key elements of responding to Hospice ADRs. Monday Minute with Melinda gives agencies the opportunity to receive critical weekly video updates, Make sure to stay tuned!

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2021 Hospice Final Payment Rule

The Hospice FY2021 Final Wage Index and Payment Rate Update from CMS is summarized in this post with changes for Hospice providers. The new regulations will be effective on October 1, 2020. The overall economic impact of this final rule is estimated to be $540 million in increased payments to hospices for FY2021. HPS is working to keep Hospices informed of all the details related to the changes with the 2021 Final Rule.

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COVID-19: Interim Final Rule & What It Means for Home Health

There have been two Interim Final Rules, the most recent on May 1, that have been issued by CMS during this historic pandemic of the century. This Public Health Emergency (PHE) has taken the full focus of national officials and in the process, there have been sweeping concessions for healthcare, some permanent and others temporary.

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COVID-19: Imperative Home Health and Hospice Updates

This article was last updated on May 7, 2020.

As we are facing the pandemic of the century, home health and hospices are on the frontline of this Public Health Emergency (PHE) along with hospitals, physicians and all other healthcare workers. We at Healthcare Provider Solutions, Inc. would like to take this moment to thank each and every one of you for your true dedication to treating patients and helping the world to be a healthier place. HPS is dedicated to providing the Home Health and Hospice industries with the education and resources necessary to keep you performing at the highest level of success.

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Hospice Targeted Probe and Educate – Avoid Claim Denials

Targeted Probe and Educate (TPE) is continuing to be a problem for Hospice providers with some advancing to rounds 2 and 3 of the audit. This demonstration, which includes hospices receiving 20-40 claim requests for Additional Development Requests (ADR) in each round, have hospices wondering if they are going to be targeted next. In order to avoid advancing to the next round of TPE, the hospice’s calculated error percentage at the end of each round must be less than the percentage set by the MAC.

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Documenting Hospice Eligibility for a Cardiopulmonary Diagnosis

When documenting hospice eligibility for a cardiopulmonary diagnosis you MUST go beyond the disease-specific LCD guidelines to avoid denial under medical review.  Many people who suffer from advanced cardiopulmonary disease share multiple symptoms as the disease progresses, however, the symptoms affect each patient differently and therefore, must be documented this way in order to support each patient’s terminal condition.

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Targeted Probe & Educate (TPE): Top 5 Hospice Denial Reasons

As long as hospices are carefully documenting the details of each patient’s clinical situation and each patient meets the eligibility requirements for hospice care—these denials are avoidable. Don’t be the hospice that gets technical denials for careless mistakes, like incorrect format of the election statement or completing CTIs with boxed/canned statements that are not specific to the patient.

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8 Major Changes Outlined in the FY2020 Hospice Wage Index Update

The FY2020 Hospice Wage Index & Payment Rate Update & HQRP Proposed Rule presents significant changes to rates and election statements. This proposed rule needs our full attention and comments! Please do your part and comment by the deadline stated in this article.

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Documenting Hospice Eligibility for Alzheimer’s Dementia

When admitting a patient to hospice with a primary terminal diagnosis of Alzheimer’s disease, your documentation should clearly show the nature and condition causing the hospice admission in addition to, the hospice disease-specific LCD guidelines.

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Required Hospice GIP Documentation

General Inpatient (GIP) Care is one of the four levels of care available to patients who elect the Medicare Hospice Benefit. When may GIP level of care be appropriate? When is it NOT appropriate to use GIP level of care?

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Top Denial Reasons – Hospice Targeted Probe and Educate

Targeted Probe and Educate (TPE) is underway for Hospice Agencies. HPS is seeing many ADR denials with agencies moving to round 2 and 3 of TPE from both CGS and NGS.

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Targeted Probe and Educate – What We Have Learned So Far

Targeted Probe & Educate began on 10/1/17 and is full speed ahead. HPS has discovered nuances with TPE that we did not expect nor have we experienced in past ADR reviews. This review includes targeted medical review and education along with the potential of elevated action toward the agency. This elevated action could take place if the agency is not meeting the standards laid out by the Medicare MAC.

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Preparing for Hospice Targeted Probe and Educate (TPE)

As previously reported, the targeted probe and educate (TPE) process is replacing the medical review process used by Medicare Administrative Contractors (MAC).  Each of the three MACs – Palmetto GBA, NGS and CGS – can choose the topics for review under TPE based on existing data analysis procedures.

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Hospice CTI and Election Statement Made Easy

CMS reminded hospices recently about the need to comply with Medicare hospice election statements and certification of terminal illness (CTI) requirements. This reminder comes shortly after CMS’ announcement of the expansion of the targeted probe and educate (TPE) method of medical review to hospices and other provider types. We believe there is a strong possibility that CMS will…

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Targeted Probe and Educate

HPS reported recently regarding continued Probe & Educate for Home Health agencies. This is to clarify that the CMS expansion on Probe & Educate is for Home Health and Hospice and will be effective 10/1/2017. This is referred to as Targeted Probe & Educate (TPE). This review will include targeted medical review and education along with an option for potential elevated action, up to and including referral to other Medicare contractors including the Zone Program Integrity Contractor (ZPIC), Unified Program Integrity Contractor (UPIC), Recovery Audit Contractor (RAC), etc.

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Hospice General Inpatient Care

CMS continues to be concerned about hospice over utilization and hospice underutilization of the general inpatient (GIP) level of care. Are hospices providing access to all four levels of hospice care (routine home care, general inpatient care, respite care and continuous home care)?

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Hospice Quality Reporting Program Update – HIS and Hospice Compare

CMS recently released clarification of the response options for HIS item A1400, Payor Information.  Many hospices have been asking how to complete this item with questions about the Self Pay option, in particular.  In addition to the information in the HIS Manual, CMS provides the following additional information specific to the…

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Attending versus Referring Physician in Hospice

A physician refers a patient to hospice care – what role does this physician play in the care of the patient and in certifying the patient? It depends. Let’s look at the various hospice requirements that involve a physician.

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Hospice Proposed Rule

In addition to the proposed changes for hospice providers CMS included proposed changes to the Home Health Quality Reporting program (HH QRP) to resume in the reporting for January 2022. The proposed rule for hospice and home health QRP is summarized in today’s blog.

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HIPAA for Home Care | Establishing A Compliant Agency

HIPAA has become an acronym synonymous with healthcare. We see it practiced and preached daily throughout the home care and hospice industry. However, too often breach notifications are at the top of our industry headlines. These breaches are costing our agencies time, money, and patient credibility. If we as agency owners, administrators, and employees understand the severity of a breach then why are breaches still occurring?

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Hospice Regulatory Update

Over the last few weeks there have been updates that hospice should be aware of:  the 2017 Final Rule has been issued and Medicare MACs have finally acknowledged that the…

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Hospice CAHPS Surveys Will Affect Payment

The regulatory issues just keep mounting with both home health and hospice. This information is technically not new, but needs to be reiterated for hospices that may not be as…

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New G-Codes Not JUST for HOSPICE!

Change Request (CR) 9369 was released by CMS on Friday, October 16, 2015, providing Additional G-Codes that will differentiate Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) in Home Health…

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Initials and Not a Full Signature, Allowed?

One of the things home health and hospices frequently have issues with is physician signatures. Often the issues surround the physician not dating their signature or making changes on hard…

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The Y2K of Coding!

Most of you will recall the scare that ran rampant throughout the country with Y2K, well basically the same thing happened with ICD-10 Coding. We were able to get a…

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Finally Some Relief or Not!

There is not much that is more frustrating than receiving a denial after submitting a chart to a reviewer, resolving the issue and then under appeal it is denied again…

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Home Care and Hospice: Still No Relief!

It was announced last week that Home Care and Hospice would receive NO relief from ICD-10 codes being required on Home Care and Hospice claims. Earlier this year, CMS issued…

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Hospice Update on Attending Physician

Centers for Medicare & Medicaid Services (CMS) has rescinded Change Request 9114 and has posted a replacement CR 9114 and a related Medlearn Matters article. This is in response to…

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Are You Convinced Your Agency is ICD-10 Ready?

The Medicare Administrative Contractors (MACs) will be conducting both Acknowledgement Testing and End-to-End Testing for ICD-10 readiness. Agencies will not even need to register for Acknowledgement Testing. However, agencies MUST…

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