Hospice Audit Series: The Second Guessing of Billed Hospice Physician Visits

Hospice Audit Series

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today's Episode: The Second Guessing of Billed Hospice Physician Visits

Today, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Erin Burns to discuss the recent denial of physician visits. Over the last several months, a number of auditors have begun questioning the medical necessity of billed physician visits, claiming the physician services were solely administrative in nature. They break down the criteria auditors appear to be using, what this means for hospices and how hospices can avoid such denials. We hope you enjoy the conversation.