The Hospice Guide to Billing and Reimbursement:
Durable Guidance and Strategy for a Shifting Payment Landscape
Casey Grimes
Catherine Stapleton, MS

The industrywide march toward standardized performance measurement and unified value-based payment structures requires hospice agencies to stay on top of CMS regulatory guidance. "The Hospice Guide to Billing and Reimbursement"is your comprehensive solution to implementing accurate, compliant, and competent billing practices at your organization. This book will help you provide the best training possible to your administrative staff and those who impact billing, increasing their competence and confidence about billing requirements and practices. It will equip providers with the broad frameworks and processes needed to develop billing systems and financial plans that meet CMS ever-sharper scrutiny.

This book will help you understand: Regulators expectations surrounding billing and reimbursement for the Medicare hospice benefitRecent updates to payment terms, such as the introduction of the Service Intensity Add-on (SIA) and the two-tiered reimbursement structure for the provision of routine homecareWhat you need to do to prepare for the major changes still ahead (e.g., value-based purchasing models)How not to leave money on the table or be penalized unnecessarily
Table of Contents: Today s Hospice Reimbursement and Billing Landscape at a GlanceOverview of the Medicare hospice benefitFoundations of hospice billing and reimbursementKey developments in recent yearsLarge-scale changes on the horizonLinking Hospice Philosophy, Care Practices and Outcomes, Operational Processes, and Received PaymentPromoting Ongoing Compliance With Long-Standing Components of Hospice Payment and BillingHonoring patient eligibility requirementsUnderstanding sequential billingDistributing Medicare coverage noticesCreating effective cost reportsResponding to additional development requests (ADR)Withstanding auditsAdapting Practices and Processes to Accommodate Recent, Industrywide Payment Rate and Process ChangesThe SIA and two-tiered RHC payment model introduced through 2016 rulemakingRecent adjustment to hospice caps calculation methodologyIntegrating the hospice PEPPER report (including recently updated coverage areas) into internal billing compliance initiativesAdhering to quality reporting expectations to avoid payment penaltiesPromoting timely filing of election notices and recertifications, as well as timely completion of face-to-face documentationCurbing high rates of recertification and revocationImplementing effective compliance strategies surrounding the launch of ICD-10 and general coding-related practices (including clinical documentation) that can influence paymentRecognizing and Readying Internal Systems for the Prospective Impact of Continuumwide Payment Reform InitiativesValue-based purchasingBundled paymentsAccountable care organizations (ACO)Implementing Enduring Billing Best Practices, Strategies, and Systems to Facilitate the Receipt of Deserved ReimbursementComplying with setting-specific guidelines, rules, and regulations, especially those governing hospitals, skilled nursing facilities, and assisted living facilitiesDeveloping effective initial and ongoing staff training"
About the Author: Casey Fenton and Catherine Stapleton, MS, are directors at Precipio Health Strategies, a Washington, D.C. based healthcare advisory and consulting firm that specializes in helping providers create and implement business growth strategies among the changing payer landscape. "