How to Prevent Overpayments

The OIG’s Annual Workplan for 2022 includes the continuous auditing and monitoring of items and services provided to hospice beneficiaries during a hospice period of care. So provider organizations must conduct routine audits to ensure that all reimbursements received are for items and services that treat conditions related to the beneficiary’s terminal illness and related conditions.

Recently the OIG audited Tidewell Hospice, Inc., and estimated at least $8.3 million in Medicare reimbursement for hospice services that were not compliant.

“Tidewell claimed Medicare reimbursement for hospice services for which the clinical record did not support the beneficiary's terminal illness prognosis or the level of care claimed and for services that were not eligible for Medicare reimbursement. These improper payments occurred because Tidewell’s policies and procedures for ensuring that claims for hospice services met Medicare requirements were not always effective. On the basis of our sample results, we estimated that Tidewell received at least $8.3 million in Medicare reimbursement for hospice services that did not comply with Medicare requirements.”
–OIG.HHS.GOV

Tune into this free webinar, “Hospice Benefits and How to Prevent Overpayments to Your Organization,” with one of our all-time favorite auditing experts, La Tanya McNair, to learn how to prevent overpayments to your organization. This in-depth webinar will teach you how to:

• Ensure beneficiaries are not receiving nonhospice items and services during a hospice period of care.
• Use (or not use) billing modifiers to audit nonhospice payments.
• Identify the essential documentation for provider organizations to re-certify a beneficiary’s terminal illness.
• See the importance of facility notifications.