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.
The degree to which your hospice can ensure regulatory compliance, demonstrate patient eligibility, and mitigate risk is directly proportional to its long-term viability.
Compliance services can include:
- Analyzing census statistics to determine case mix and identify potential risks.
- Conducting a pre-billing audit of selected clinical records to evaluate compliance with all technical requirements, documentation of initial and ongoing clinical eligibility, eligibility for higher levels of care, and compliance with other Medicare Conditions of Participation
- Evaluating the hospice's documentation tools and/or the electronic health record (EHR)
- Observing the interdisciplinary group meeting to assess its nature, content, and efficacy and evaluate the documentation of care plan and drug profile updates
- Auditing selected personnel files to ensure regulatory compliance
- Interviewing selected leadership and staff members to identify potential knowledge gaps and areas for improvement
- Evaluating your Corporate Compliance Program
- Reviewing the clinical infrastructure, including satisfaction surveys, on-call logs, complaint logs, Quality Assessment and Performance Improvement (QAPI) data, infection control data disaster preparedness
- Reviewing additional components of the administrative infrastructure, including the governing body, billing, contracting, and policies and procedures
- Evaluating your hospice's level of exposure with regard to the 28 risk areas identified by the OIG
- Reviewing your HIPAA program
- Conducting quarterly pre-billing clinical record audits to evaluate compliance with all technical requirements, documentation of initial and ongoing clinical eligibility, eligibility for higher levels of care, and compliance with other Medicare Conditions of Participation
- Preparing a detailed report of all findings and facilitating a conference call to discuss outcomes and next steps
- Preparing and leading a customized educational program
Weatherbee works to understand your specific needs for Compliance Audits and delivers customized remote and/or onsite services.
Engaging Weatherbee will result in:
- Understanding your risk exposure due to non-compliance;
- Identifying strategies to mitigate current and prevent future risks;
- Changing policies, procedures and staff behaviors that led to risk exposure; and
- Implementing monitoring systems to ensure early detection of emergent risks.
Please contact Weatherbee for additional information regarding Compliance needs.