The part that gets my attention is what could happen if CMS finds a problem with your Medicare enrollment. Today, some enrollment terminations take effect going forward, while certain situations can already be made retroactive. CMS is now proposing to make all of them retroactive to the date CMS determines the problem actually began. That could turn what looks like an administrative mistake into a very significant financial problem.
Think about this in simple terms. CMS finds an enrollment problem with your hospice today, but determines that the problem actually started six months ago. If this proposal becomes final, CMS could potentially make the termination effective six months earlier and seek repayment of Medicare money paid during that time. You provided the care, paid your nurses, paid pharmacy and DME, and covered all of the expenses of caring for those patients, but now months of reimbursement could potentially be at risk.
This is why I think hospice owners need to stop looking at Medicare enrollment as paperwork that someone in the office takes care of when something changes. Your Medicare enrollment information includes important information about your organization, including ownership, managing employees, locations, licenses, and organizational changes. That information needs to accurately reflect what your organization looks like today.
I would not wait to see whether this proposal becomes final before reviewing your information. Pull your Medicare enrollment records and compare them with your organization. Make sure your ownership information is correct. Make sure managing employees and locations are current. Verify licenses and review any ownership or organizational changes that may have occurred. Most importantly, make sure someone is clearly responsible for keeping all of this information current.
This does not mean every typo or administrative mistake is suddenly going to cost a hospice months of Medicare reimbursement. This is still a proposed rule, not a final rule. But it does tell us something important about the direction CMS is moving and how seriously we need to start treating Medicare enrollment compliance.
Hospice compliance has traditionally focused heavily on the clinical record, and that absolutely still matters. But compliance is becoming much bigger than the chart. CMS is looking at ownership, enrollment, billing, operations, clinical documentation, and the information it has about the people managing the organization. Hospice owners need to know that all of those pieces are accurate.
The biggest concern for me is the potential financial impact. Losing the ability to bill Medicare going forward would obviously be devastating. Having CMS determine that your enrollment problem actually began months earlier and potentially seek repayment for that entire period creates a completely different level of exposure.
The good news is that this is something hospice leaders can look at now. You don’t have to wait for an audit, investigation, or letter from CMS to find out whether your enrollment information is accurate. Review it, make sure it matches your organization, and put a process in place to keep it current.
This proposal may change before it becomes final. But if CMS ultimately adopts it, something that looks like a simple administrative mistake today could become a very expensive compliance problem tomorrow. Medicare enrollment is no longer something I would treat as routine paperwork.
The Amity Group is a one-stop organization designed to support hospice agencies with everything from staffing to education to compliance and beyond. We are the hospice experts and hospice is all we do. www.amitystaffing.com.
