Something significant is happening in the hospice sector that leaders need to pay attention to. The Centers for Medicare & Medicaid Services (CMS) is beginning to share more insights regarding the claims reviewed by Medicare contractors, offering a clearer picture of what’s really occurring in hospice documentation.
Understanding the Targeted Probe and Educate (TPE) Program
One area I believe hospice leaders should be watching closely is the Targeted Probe and Educate (TPE) program, a method Medicare contractors use to assess providers when they suspect issues with claims or documentation. Starting November 2nd, these contractors will be required to publish quarterly results from their TPE reviews, including the most common reasons for claim denials. This development doesn’t introduce new rules but provides invaluable data for hospice organizations:
“Instead of talking about documentation problems in very broad terms, hospice leaders will be able to look at real denial patterns.”
This shift allows organizations to identify specific mistakes that may be recurring in their own charts, enabling them to address issues proactively.
The Importance of the New Hospice Election Addendum Requirement
Alongside the TPE updates, the new hospice election addendum requirement took effect on October 1st. While there’s a transition period until December 31, 2026, during which claims won’t be denied solely for missing or incomplete addenda, I believe hospices should use this time to get this right:
“This is an opportunity. Hospices should be using these three months to look at every new election.”
Organizations must ensure they are providing the addendum promptly, updating it when necessary, and understanding its significance. I believe thorough documentation should tell a coherent story about patient eligibility and care.
Embracing Data-Driven Compliance
As the hospice landscape becomes increasingly data-driven, organizations should take advantage of the information now becoming available. I believe technology and the responsible use of AI can help us detect patterns in documentation errors before they become larger problems:
“I believe the future is not about using technology to replace hospice nurses or clinical judgment. It’s about giving good people better tools.”
However, simply implementing technology won’t solve underlying issues:
“Technology cannot fix a bad process.”
The strongest hospice organizations will adapt quickly, watch CMS updates, and audit their own processes to ensure compliance and improve care.
A Call to Action for Hospice Leaders
I believe we need to rethink the way we look at compliance. It should not merely be a defensive measure against oversight. It should be a proactive approach that helps us improve the quality of care:
“Compliance should not only be about defending what happened yesterday. It should be helping us to make tomorrow better.”
The future of hospice care lies in using better information, better education, and better tools. The organizations that embrace this mindset will be the ones helping lead our industry toward better patient outcomes.
For a deeper dive into these ideas, listen to the full episode.
