Hospice Law And Beyond

In today's episode, Meg talks with Chris Comeaux, President/CEO of Teleios Collaborative Network. Formed in 2017, TCN is an organizational model that allows its 9 non-profit hospice members to maintain their local identity with the support and resources of a larger organization. With years of leadership experience under his belt, Chris provides unique insight into the trends he currently sees, including innovation, and how the hospice industry can prepare for future.

As Bryan comments in today's episode, "preparation brings peace of mind." It is increasingly important to be prepared as government visits seem to be on the rise. The FBI, OIG and DOJ appear to be knocking on hospices', hospice employees' and hospice patients' doors more often. Listen as Meg and Bryan talk about what hospices should do to be prepared and appropriately respond if and when the government shows up.

This week’s episode features Tim Bowen, President and CEO of Care Synergy, which is comprised of five non-profit hospice affiliates in Colorado. Through our conversation, Tim shares both his passion for community based hospice care and thoughts on how hospices can innovate their way into the future. From competitive advantages, better communication, and new technology, such as self-driving cars, Tim talks about how non-profits can be poised for success as the carve-in to Medicare Advantage looms.

CMS recently released a final rule regarding forthcoming changes to 855 enrollment and revalidation applications, aimed at identifying individuals and entities who pose a risk to the Medicare/Medicaid programs. As Part A providers, hospices eventually will be required to comply with this rule and provide information regarding “affiliations” and any “disclosable events” associated with such affiliations. Listen as Meg and Karla breakdown the rule and what proactive actions hospices should consider taking now.

Reinhart analyzes the AseraCare case through its unique lens of representing hospices throughout the country for over 20 years.  While ostensibly a federal False Claims Act (“FCA”) case, the court’s ruling may have a broad application that benefits hospices in other enforcement contexts, including audits and other medical review.  The court’s specific interpretation of the Medicare Hospice Benefit can also guide hospices’ day to day operations.

This week, I talk with Amy Cannizzo-Brennan, the Vice President of Excellence/Corporate Compliance Officer of Trustbridge. Amy shares how she came to the hospice industry (which includes a brief stint as a dog groomer) and what has made her successful in her role, including keeping up with regulations and appropriately assessing risk. With a focus on compliance, Amy and I discuss some of the biggest changes and issues currently impacting hospices.

In this episode, I sit down with Karen Carrig, President, and CEO of Rainbow Hospice, to talk about her experiences in the hospice industry. From hiring good people and supporting staff education, to building relationships and investing in compliance, Karen provides her insights on what makes a provider successful in today’s world.

In the final rule, CMS forges ahead with payment changes and election requirements despite objections from the hospice industry.  With expanded conditions of payment, there is a lot at stake for hospices.  We share our insights and suggest action items for what hospices can do now to prepare for rate changes and the new election requirements.

In this week’s episode we tackle hospice physician relationships. While nothing has changed in terms of physicians being critical members of any hospice organization, the government is becoming more focused on the roles these physicians play beyond direct patient care. From robust certification/recertification requirements to defending audit results, the stakes are higher for hospices, and in turn the expectations are greater for medical directors and other hospice physicians. We discuss the importance of precise contracts for outlining physician duties and corresponding compensation. Beyond this podcast, stay tuned for updates on our forthcoming medical director and other hospice physician contract templates, which may be a good starting point for your organization.

It may be summer break for some, but not for CMS contractors! There seems to be quite a bit of audit activity throughout the country, and in this episode we discuss two types of audits we are seeing (Center for Program Integrity and UPIC Pre-Payment Audits). We also provide an update to Episode 2 regarding SMRC audits as results from Round 1 come in and Round 2 requests begin.

OIG made a splash with two eye-catching reports yesterday that focus on “risks” to Medicare hospice beneficiaries. Reinhart trio, Karla, Bryan and Meg, peel back the layers and pose questions that put these reports into perspective. Despite the reports’ shortcomings, Reinhart suggests how CMS can use these reports to bring about positive change.

In this episode I share a wide ranging conversation with Jeff Lycan, Executive Vice President of Mission Advocacy at Ohio’s Hospice. Jeff shares a wealth of knowledge on where hospice has been and how hospices can position themselves for success in the future. With a keen insight into the policy and payment changes on the horizon, listeners will gain new ideas on how to approach the challenges of tomorrow.

In this podcast, we share insights from our work on a variety of multiple location issues.

In this episode, we talk with Liz Fowler, CEO of Bluegrass Care Navigators in Lexington, Kentucky. Listen to how Liz entered the hospice industry and the lessons and strategies she uses to lead and motivate through changing times. Liz’s insights serve as helpful takeaways that you can put into action within your organization.

The Attorney-Client Privilege allows hospice to refrain from disclosing certain confidential communications to the government, its auditors, or other parties, even if that information is formally requested by a record request, subpoena, or otherwise. The privilege, if appropriately utilized, allows hospice leadership and personnel to have candid discussions with their attorneys about compliance matters (including audits and internal investigations) and is an essential tool for any hospice that may find itself involved in litigation. In this podcast, you will learn how to effectively make use of the Attorney-Client Privilege to improve your compliance efforts and to better manage False Claims Act and other litigation risk.

In this podcast, we share “hot off the press” news on recent payment denials hitting hospices throughout the country relating to the accuracy of physician and nurse practitioner National Provider Identifiers (“NPIs”) reported on claims. This new government focus is causing headaches for hospices and taking an unnecessary bite out of pocketbooks. Listen in as we share insights on how to avoid these “avoidable” errors and make sure your practitioners are active in the Medicare system.

From time to time, hospices receive subpoenas commanding them to produce documents (including patient records) or to have hospice personnel appear at a hearing. Blindly producing documents may violate HIPAA, while ignoring a subpoena could lead to contempt of court or obstruction of justice charges. In this podcast, learn how to navigate the appropriate middle ground to thoughtfully, efficiently, and lawfully comply with a subpoena.

As with most compliance issues, you hope never to deal with this, but a lapsed professional license is a reality that regularly comes across our desk. In this podcast, we share “lessons learned” and walk you through a hospice’s legal obligations, including reporting requirements, potential repayment liability and corrective actions.

The results of the latest wave of SMRC audits are coming in. The SMRCs continue to focus on GIP eligibility, but they are also scrutinizing the identification and roles of attending physicians. Hospices can proactively address the results of these audits early on by accepting the SMRC’s invitation to engage in a telephonic Discussion and Education (“D&E”) session with the auditors. In this episode, learn what these D&E calls are all about, including what happens during the call how to prepare to address the GIP and attending physician issues what happens after the call The information covered can also inform policies and practices for hospices who are not currently subject to SMRC audits.

While we saw a lull in multi-million dollar extrapolated audit results over the past couple of years, statistical extrapolation is back and likely to accompany many hospice audits going forward. This doesn’t come as a surprise, as CMS signaled this renewed extrapolation effort when it issued revised statistical sampling guidance in September 2018 with an effective date of January 2, 2019. Even in the first couple months of 2019, we are seeing more statistical extrapolations. Now is the time to stay alert and get prepared, because audits may take on renewed significance as the potential amounts at issue increase substantially. To learn more about CMS’s new guidance, check out our podcast. You can also find audit preparation tools in the Reinhart Hospice Law Library. Feel free to call a member of our Hospice and Palliative Care Team to discuss these new developments.