Hospice and Palliative Care

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Our consultants are respected as the premiere compliance experts in Hospice and Palliative Care physician services.

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We are honored to be the only consultants with this expertise to be able to include both the National Hospice and Palliative Care Organization (NHPCO) and the American Academy of Hospice and Palliative Medicine (AAHPM) as clients of the firm.

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While most hospices have fairly robust compliance programs, quite typically a focus on physician billing is missing. We help to ensure that an organization can incorporate compliance functions for physician billing while optimizing the revenue stream.

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Acevedo Consulting understands that compliance has been thrust onto the top of your organization's priorities especially with the OIG's Work Plan expanding inquiries into the inner working of the hospice industry.

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We recognize that with the hospice industry in the midst of significant regulatory changes and increased scrutiny, it is more important than ever to understand these changes and the implications to your hospice program from a regulatory compliance perspective.

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When a patient is receiving hospice and/or palliative care services, billing for physician patient care services can be very complex.  Acevedo Consulting appreciates that optimizing physician billing requires an understanding of the regulatory requirements of the levels of care under the Medicare Hospice and Fee-for-Service Benefits. CPT codes and modifiers vary based on the location of service as well as the physician’s role with respect to the patient and the hospice/palliative care organization.  And, as the use of nurse practitioners expands, consideration must be given as to how best to incorporate these practitioners into the program and still be compliant with the regulations. An incomplete understanding of these factors can not only lead to loss of revenue for your hospice but also a loss of referral sources if referring physicians are being denied billing for hospice patients. Our expertise can assist you in reviewing the various relationships and the appropriate approach to billing for each.

 

Properly documenting a patient’s visit using the documentation guidelines for Evaluation and Management Services continues to be a challenge for physicians and nurse practitioners. Acevedo Consulting can help ensure third-party payers are not successful in retrospective recoupment and that your hospice or palliative care program is able to optimize the revenue potential of physician services with services such as CCM, TCM, QPP, VBPM, etc. 

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It's clear that the Medicare program is paying more attention to services billed by hospice and palliative care providers through increased use of ADRs. CMS' goal is to reduce/prevent improper payments. And, as all government budgets tighten, it should not be surprising that the Medicare program will continue to look for potential overpayments through the audit process. Acevedo Consulting was deeply involved with the Recovery Audit Contractor's audits during the 3-year demonstration program. Allow our experiences and expertise to aid you in preparing for the inevitable audit.

 

Our understanding of and particular expertise in the industry's nuances is paramount to balancing risk and practicality within your Hospice/Palliative Care organization.

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