Weatherbee's executive and consulting teams assist hospices with acquisitional and organic growth, rightsizing and reorganizing, strategies for successful management and performance, qui tam and other investigations, and a host of compliance and improvement-oriented endeavors.
Contact us to explore how Weatherbee can help your hospice.
ADRs & Appeals
Weatherbee assists hospices with Additional Development Request (ADR) submissions, appeals, and education to identify and mitigate risk exposure.
Weatherbee works with hospices that have been targeted by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) regarding their high percentage of long stay and/or facility-based patients; those in receipt of probe edits from Medicare Administrative Contractors (MACs); and, those hospices under the review of a Zone Program Integrity Contractor (ZPIC), Recovery Auditor (RA), and other organizations investigating payment-related issues.
When seeking to acquire an established hospice program, conducting pre- and post-acquisition clinical due diligence is a crucial step in evaluating the overall feasibility and advisability of the acquisition as well as its subsequent success.
Weatherbee Resources can serve as your Independent Review Organization (IRO) for the purpose of reviewing all the data elements that substantiate your hospice's compliance with the Corporate Integrity Agreement (CIA) and evaluating the eligibility of patients to elect the Medicare/Medicaid Hospice Benefit.
Weatherbee provides interim management and coaching to assist hospices through periods of transition, filling vacant leadership positions, and providing coaching to new leaders ascending to senior positions in your organization.
Any hospice can be selected for an investigation or audit. An investigation of any kind is disruptive to the organization, may damage your reputation in the community and could seriously threaten the financial viability of the program.
Clinical Record Audits
How good is your team's documentation? Do you have systems and processes in place to give you confidence that every bill submitted will result in payment?
Periodic external reviews of your documentation can identify potential issues before they become major problems.
Weatherbee offers advisory services for hospice Medical Directors and physicians, provided by well-qualified physician experts.
The Improving Medicare Post-Acute Care Transformation Act (IMPACT) Act requires that the Centers for Medicare and Medicaid Services (CMS) ensure that each Medicare-certified hospice agency undergo a survey at least once every 36 months for the next 10 years. This requirement became effective in April 2015; however, many hospices have gone 5 or more years since their last survey and are uncertain what the outcome will be for their next CMS/State survey.
The list of compliance and fiscal challenges facing hospices is beyond daunting. Hospices that had previously experienced a growing census and healthy bottom line are, at best, watching their operating margins shrink.
Weatherbee's newest consulting services, offered in conjunction with the kb group, focus on helping to grow your organization and increase your bottom line.
A critical component of a hospice's corporate compliance program is a mechanism for staff to report potential fraud and abuse. An effective reporting mechanism allows staff to raise concerns without fear of retaliation.
The Program for Evaluating Payment Patterns Electronic Report (PEPPER) summarizes your hospice’s Medicare claims in target areas that may be at risk for improper Medicare payments, allowing hospices to identify specific areas in need of focused attention.
While the PEPPER can be daunting, particularly for those who may be intimated by interpreting the statistics, it provides critical information regarding billing risk areas specific to each hospice.
The PEPPER currently includes these hospice target areas:
- Live Discharges Not Terminally Ill
- Live Discharges – Revocations
- Live Discharges LOS 61-179 Days
- Long Length of Stay
- CHC in Assisted Living Facility
- RHC in Assisted Living Facility
- RHC in Nursing Facility
- RHC in Skilled Nursing Facility
- Claims with Single Diagnosis Coded
- Episodes with No GIP or CHC
Weatherbee provides three distinct levels of consultation and education services to hospices allowing each client to select the specific services that meet its needs:
Level I – PEPPER Education
PEPPER Education offers live a web-based presentation as a general introductory educational program. This session can be attended by a large group, or viewed by individuals on the management team. Weatherbee’s clinical and statistical consultants will present:
- Explanations of the PEPPER and its metrics
- Statistical concepts that are used in PEPPER
- Demonstrations of how the PEPPER identifies potential payment risks
- Ways to identify how the report can highlight potential opportunities
Level II – PEPPER Consulting Services Package
The PEPPER Consulting Services Package is a focused, hospice-specific service (i.e., per provider identification number). Clients receive the following services, specific to the hospice’s individual PEPPER:
- Expert analysis, evaluation, and a brief summary report of the hospice’s PEPPER, including risk areas, opportunities and recommendations
- A live web-based meeting with the hospice’s leadership to present the findings, analysis, and evaluation of the PEPPER statistics, answer questions, describe strategies to manage risks, outline opportunities, and provide suggestions for future monitoring of risk areas
- One hour of telephone technical assistance after the live web-based meeting to answer questions related to the PEPPER or recommendations
Level III – PEPPER Custom Consulting Service
Weatherbee’s PEPPER Custom Consulting Service is designed to provide ongoing, customized support to your hospice. Custom consulting services may include, but are not necessarily limited to:
- Custom presentations specific to the individual hospice’s PEPPER for the C-suite, governing body, and quality and compliance team
- Development of a predictive PEPPER-like report
- Development of a quality dashboard
- Management of audit risk
- Guidance to improve best practices
- Integration of PEPPER data and quality programs
Weatherbee's goal is to assist each hospice in identifying the best strategy to improve areas highlighted in the annual PEPPER.
Dependent upon the Level selected, engaging Weatherbee will result in:
- Enhancing the ability to understand the PEPPER and its metrics
- Identifying risk areas based on the specific PEPPER report
- Developing strategies to manage risk areas
- Optimizing business opportunities to better serve your community
- Expanding the quality department’s ability to monitor internal data to predict future risks
- Integrating best practices specific to PEPPER risk areas
Please contact Weatherbee for additional information regarding PEPPER Services.