3 strategies for hospice GIP compliance
3 strategies for hospice GIP compliance
Hospice News; by Jim Parker; 10/21/24
Utilization of the general inpatient level of care (GIP) is frequently the subject of audits by Medicare Administrative Contractors (MACs), and avoiding or responding to that scrutiny requires strict compliance to a complex web of rules. Audits are becoming more frequent in the hospice space, and GIP is an increasing focus, including for the most common types — Supplemental Medical Review Contractor (SMRC) and Targeted Probe and Educate (TPE). ... In addition to these routine MAC audits, the U.S. Department of Health and Human Services Office of the Inspector General (GIP) has been performing a national audit of GIP utilization, as well as an additional investigation into management of the associated payment cap. The inpatient cap limits the number of days of inpatient care for which Medicare will pay to 20% of a hospice’s total Medicare patient care days, according to OIG. If GIP billing exceeds that metric, the hospice must refund those payments to Medicare. ... Hospices and other stakeholders have developed a variety of methods, tools and resources for complying with GIP requirements. Among them, three key themes stand out.
- Understanding the requirements ...
- Effective documentation ...
- Be prepared ...