Tip of the Month Hospice Drug Coverage and Medicare Part D: A Potential Compliance Risk
Hospice providers run the risk of pharmacy audits from any number of governmental and commercial insurance entities. To reinforce this point, consider the June 2012 report by the Office of the Inspector General (OIG): Medicare Could Be Paying Twice for Prescription Drugs for Beneficiaries in Hospice. According to this report, 198,543 beneficiaries received 677,022 prescription drugs through Medicare Part D that potentially should have been covered under the per diem payments made to hospice organizations. No matter who the auditor may be, however, the focus is the same: Were there medications charged to another payer that should have been covered by the hospice? To ensure optimal compliance, hospice providers should initiate the following actions: 1. Complete a comprehensive assessment of the patient’s medications and clearly document in the clinical record which medications will be covered under hospice. 2. Discuss with the patient and family which medications will not be covered by the hospice—and why. 3. Complete an assessment of patients residing in a nursing facility to ensure that pharmacies are not billing hospice-related medications to another payer once a patient has elected the hospice benefit.
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http://oig.hhs.gov/oas/reports/region6/61000059.pdfhttp://oig.hhs.gov/oas/reports/region6/61000059.pdfhttp://oig.hhs.gov/oas/reports/region6/61000059.pdf
Table of Contents for the Digital Edition of NewsLine - August 2012