Literature Review

Facing new CMS pressure, providers should audit mental health diagnoses, prescriptions: expert McKnights Long-Term Care News; by Kimberly Marselas; 7/22/25 As reported in McKnight’s Long-Term Care News on July 23, “Nursing homes should be auditing documentation for all residents with mental health disorders to ensure their diagnoses are compliant with new federal guidance, a well-known clinical reimbursement recommended Tuesday. Leigh Ann Frick, president of Care Navigation Consulting, made that suggestion while reviewing updated Long-Term Care Surveyor Guidance that went into effect in late April. At over 900 pages, the new manual and appendixes have left many providers still navigating the changes and how best to respond to them. When it comes to giving antipsychotic medications, diagnosing patients with disorders that require them, or identifying and responding to any other patient needs, the guidance puts new emphasis on the use of professional standards, Frisk explained. Guest Editor’s Note, Judi Lund Person:  For nursing home residents who have elected the Medicare hospice benefit, this information may apply. Diagnosing mental health issues, prescribing, and documenting based on professional standards is an important component in the updated Long-Term Care Surveyor guidance issued in April.

Perform detail-oriented internal audits to avoid common denials DecisionHealth - Home Health Line; by MaryKent Wolff; 7/18/25 The most common reason for hospice denials in the first quarter of 2025 was that the claim was not hospice appropriate, according to Palmetto GBA, a Medicare Administrative Contractor (MAC) servicing 16 states. Palmetto released its list of the top 10 hospice medical review denial reasons from January to March 2025 on May 16. [Subscription required.]

51 healthcare leaders’ takes on doing more with less Becker's Hospital Review; by Allie Woldenberg, Kelly Gooch, Mariah Taylor, Giles Bruce, Kristin Kuchno, and  Andrew Cass; 7/17/25 It’s a directive that hospitals and health systems of every size know well — whether sprawling academic medical centers, multistate nonprofit systems or rural, independent 25-bed hospitals. While the phrase isn’t new, the urgency behind it is intensifying. The nation’s healthcare workforce remains fragile, forcing leaders to distinguish between staffing gaps that are temporary hurdles or structural limitations. Revenue projections for health systems have shifted dramatically ... Against this backdrop, Becker’s set out to understand how health system leaders across the U.S. are interpreting and enacting the mandate to “do more with less” today. From June 9 to July 15, we spoke with executives across the country, in every type of market, hospital, and health system, to hear how they are navigating this evolving landscape. ...Editor's Note: Scan through these with a sharp eye toward improving the quality of patient care while "doing more with less." I applaud many of these leaders for not just focusing on cutting costs, but for using these crucial changes as a vehicle to improve patient care.

Medicare telehealth trends: Information on telehealth use by Medicare Fee-for-Service beneficiaries Data.CMS.gov; Centers for Medicaree & Medicaid Services; 7/16/25 Data update frequency: Quarterly Latest data available: Q4 2025The Medicare Telehealth Trends dataset provides information about people with Medicare who used telehealth services between January 1, 2020 and December 31, 2024. The data were used to generate the Medicare Telehealth Trends Report.

Medicare fraud has gone global. It’ll take a nationwide effort to stop itLos Angeles Times; by Mehmet Oz, Kim Brandt; 7/15/25Federal law enforcement recently announced a $14-billion fraud takedown — the largest healthcare fraud action in U.S. history, involving many crimes orchestrated by foreign nationals. Every American taxpayer should be alarmed not just because of the dollars at stake, but also because it reveals how vulnerable Medicare and Medicaid have become to large-scale, international exploitation... Fraud is a national problem, but it starts locally. Drive around certain neighborhoods in Los Angeles and you’ll pass what appear to be empty office buildings, which unbeknownst to neighbors could serve as hubs of criminal activity. There are more than 1,000 potentially fraudulent hospice operations identified in Los Angeles.Publisher's note: Medicare fraud is tragic - and that hospice is the highighted provider in this story is also tragic. This article includes steps that can be taken to stop this fraud. Also, thanks to Sheila Clark, President-CEO of the California Hospice & Palliative Care Association (CHAPCA) for forwarding this article.

AAPA asks CMS to remove regulatory restrictions on PAs providing hospice care American Academy of Physician Associates (AAPA); by Trevor Simon; 7/9/25 In June 2025, AAPA submitted comments to the Centers for Medicare and Medicaid Services (CMS) regarding the topics of hospice, skilled nursing facilities, inpatient rehabilitation facilities, and inpatient psychiatric facilities. These comments, in response to annually released proposed rules that make adjustments to the hospice wage index and respective fee schedules, responded directly to inquiries made within the rules, as well as identified policy obstacles faced by PAs in these settings. [Continue reading for] a brief summary of the topics AAPA discussed in each, with links to the full letters.

Health care attorneys: Hospice investigations coming from all sides Hospice News; by Jim Parker; 7/8/25 Hospices are subject to a rising number of investigations and audits from Medicare contractors, the U.S. Department of Health and Human Services Office of the Inspector General and, in some cases, the U.S. Justice Department, among others. Hospices need to understand the various types of investigations they may encounter and how to respond to them. Key factors are completely and accurately documenting the medical necessity of the care they receive. Hospice News sat down with Guillermo Beades and Todd Brower, partners with the law firm Frier Levitt to discuss the ins-and-outs of hospice investigations and how providers should respond.

Center for Acute Hospice Care to close in August 29 News, Charlottesville, VA; by Jacob Phillips; 7/1/25 After nearly a decade of offering around-the-clock end-of-life care, Hospice of the Piedmont is closing their Center for Acute Hospice Care (CAHC) on Ivy Road in Charlottesville in August. “It gives us an opportunity to concentrate more on where patients want to be, which is home, and those services will still be provided,” Hospice of the Piedmont President and CEO Nancy Littlefield said. “[CAHC] is a 10-bed unit that we lease...and it’s for patients who might be having needs of a higher level of hospice care.” Littlefield says the main reason for closing the center is the lease is coming to an end and with uncertainty surrounding federal budget cuts of hospice care, continuing in this location is not sustainable. “Our hospice, as well as all hospices across the state, are having to be very cautious about what Medicaid and other reimbursement changes may occur under the current administration,” Littlefield said, “and I think the worst thing we can do for families and patients is to not be prepared.”

CMS Age-Friendly Measure: Overview for hospitals and health systems Institute for Healthcare Improvement; retrieved from the internet 7/2/25 Starting with the 2025 reporting period, hospitals will attest to providing age-friendly care through a new measure introduced by the Centers for Medicare & Medicaid Services (CMS). The CMS Age Friendly Hospital Measure advances the Age-Friendly Health Systems movement’s vision to ensure that all older adults receive age-friendly care that is evidence-based and aligns with what matters most to the older adult and their family caregivers. To date, nearly 5,000 sites of care have been recognized as Age-Friendly Health Systems — Participants and celebrated by IHI and The John A. Hartford Foundation. The measure has five domains that cover all four elements of age-friendly care, known as the 4Ms: What Matters, Medication, Mentation, and Mobility.

The Alliance responds to Senate passage of Reconciliation Bill National Alliance for Care at Home, Alexandira, VA and Washington, DC; Press Release; 7/1/25 The National Alliance for Care at Home (the Alliance) issued the following statement today in response to the Senate’s passage of the “One Big Beautiful Bill Act,” also known as the Reconciliation bill. “The Alliance is alarmed by the Senate’s passage of the One Big Beautiful Bill Act, which prioritizes misplaced budget cuts over the health and wellbeing of our most vulnerable. The legislation will reduce access to care and support for the millions of Americans who rely on home and community-based services (HCBS),” said Alliance CEO Dr. Steve Landers. ... “The Alliance continues to maintain that the complexity of the Medicaid program makes it nearly impossible to reduce expenditures by the amounts contemplated by this legislation – potentially exceeding $1 trillion over ten years – without impacting services to older adults and people with disabilities. The Alliance will advocate on behalf of Medicaid enrollees, families, and providers nationwide ...

Nearly 50 charged in Southern District of Texas as part of national health care fraud takedown United States Attorney's Office - Southern District of Texas, Houston, TX; 6/30/25 A total of 22 cases are being announced as part of local efforts targeting health care fraud and include various schemes alleging unlawful distribution of controlled substances, some of which were diverted onto the black market, hospice fraud, kickbacks and other Medicare/Medicaid fraud schemes involving medically unnecessary genetic tests, durable medical equipment and more.  The charges filed in Southern District of Texas (SDTX) federal court are part of the Department of Justice’s 2025 national health care fraud takedown. ... One of the largest cases include three individuals for their alleged roles in a $110 million hospice fraud and kickback scheme. The charges allege Dera Ogudo, 39, and Victoria Martinez, 35, both of Richmond, operated hospice company United Palliative & Hospice Company (UPHC) that misled vulnerable elderly adults about what services were being billed to their Medicare and Medicaid plans.

CMS to test prior authorization model in traditional Medicare MedPageToday; by Joyce Frieden; 6/30/25 The Centers for Medicare & Medicaid Services (CMS) announced a new experimental model late last week to streamline some prior authorizations under the traditional Medicare program, but some politicians and experts are concerned that it could result in more delays in care. Under the model, known as the Wasteful and Inappropriate Service Reduction (WISeR) Model, "CMS will partner with companies specializing in enhanced technologies to test ways to provide an improved and expedited prior authorization process" under traditional Medicare, the agency said Friday [6/27] in a press release ...