Revitalizing a Hospice's Medicare Compliance and Revenue
The Challenge
A hospice organization struggling with documentation and coding practices, leading to significant financial losses due to non-compliance with Medicare requirements. The hospice was not using an electronic health record (EHR) system to manage patient records, leading to several compliance issues:
Inadequate documentation of care planning.
Lack of evidence showing patients' terminal conditions, justifying hospice care.
Insufficient review by the medical director.
Failure to provide necessary certifications to Medicare, affecting patient eligibility for Medicare funding.
Due to these issues, Medicare auditors reclaimed over $2 million, putting the hospice at financial risk.
The Solution
Jessica Zeff, Simply Compliance’s CEO, was brought in to address these critical issues. Her approach included:
Comprehensive Review: Jessica reviewed the audit findings, conducted her own assessment of a sample of patient records, and interviewed staff and patients' families to understand the extent of the compliance gaps.
Policy and Procedure Analysis: She analyzed the existing policies and procedures to identify areas needing improvement.
Training and Education: Developed a focused training program for staff on proper documentation requirements and compliance with Medicare billing.
Implementation of an EHR System: Advocated for the adoption of an electronic health record (EHR) system, which included:
Training staff on how to use the EHR system effectively.
Setting up reminders for medical reviews and certification deadlines.
Ensuring accurate assessment and documentation of patients' terminal conditions.
Proactive Audit Program: Assisted in developing an internal audit program to regularly check compliance with documentation requirements. This enabled the hospice to identify and correct errors before external audits.
The Results
The implementation of these measures led to a dramatic turnaround for the hospice:
Improved Compliance: The focused training and use of an EHR system ensured that documentation and coding practices were significantly improved.
Financial Recovery: Two years later, the hospice experienced a 97% improvement in revenue, maintaining financial stability and continuing to operate successfully.
Sustained Compliance: The proactive audit program helped the hospice stay ahead of compliance issues, ensuring they could keep the money earned from Medicare without fear of recoupment.
The Conclusion
Jessica Zeff's intervention transformed the hospice's operations, bringing them back into compliance with Medicare requirements and securing their financial future. Her comprehensive approach to training, system implementation, and proactive auditing provided a sustainable solution that ensured the hospice could continue to provide essential care to its patients. This case study underscores the critical role of effective compliance management in the healthcare sector.
