Hospice Audits-video1658795133

Video Transcription

Video Summary

The webinar focused on hospice audit trends, compliance risks, and new areas of scrutiny. Dr. Lauren Templeton explained that hospice is now a “high scrutiny” benefit and audits are largely data-driven rather than random. The main long-standing audit targets remain long length of stay patients, higher levels of care such as general inpatient care and continuous home care, and technical/payment requirements like election statements, certifications, and addenda. She emphasized the difference between conditions of participation, which surveyors review, and conditions of payment, which auditors review.<br /><br />A major new concern is live discharge rates. CMS has begun using live discharge data more aggressively, including in California, where many hospices received payment suspensions based on high rates. Dr. Templeton noted that a rate above 30% is a warning sign worth investigating through root cause analysis.<br /><br />Another emerging focus is the Service and Spending Variation Index (SSVI), finalized in the FY2027 rule. This measure looks at both service patterns and spending outside the hospice benefit, including Part D, Part B, and wound care-related costs. It is being treated as a program integrity risk signal.<br /><br />The session also covered respite rules, the role of the hospice physician in determining relatedness of care and medications, and why appeal outcomes through the BFCC-QIO do not protect a hospice in audit reviews. Dr. Templeton urged hospices to improve documentation, review data trends, and proactively prepare for audits.

Meta Tag

Concept Hospice Audit

Concept Hospice Conditions of Participation

Concept Conditions for Payment

Concept Long Length of Stay

Concept General Inpatient Care

Keywords

hospice audits

compliance risks

data-driven audits

live discharge rates

Service and Spending Variation Index

SSVI

general inpatient care

continuous home care

election statements

conditions of payment

Hospice Audit

Hospice Conditions of Participation

Conditions for Payment

Long Length of Stay

General Inpatient Care