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Medicare Hospice – Use of General Inpatient Care

Medicare Hospice – Use of General Inpatient Care May 7, 2013

Today the US Department of Health and Human Services Office of Inspector General (HHS OIG) published the report, Medicare Hospice:  Use of General Inpatient Care, which describes the use of general inpatient care (GIP) in 2011.  The report is based on an analysis of Medicare hospice claims; the OIG did not conduct a medical record review of the claims and did not determine whether services provided were medically necessary.

Centers for Medicare and Medicaid Services (CMS) has expressed concerns about possible misuse of GIP such as:  care being billed that has not been provided, long lengths of stay, and beneficiaries receiving unnecessary care.  The Medicare hospice benefit has four levels of care.  Of the four levels, GIP is the second most expensive level of care.  GIP is for pain control or symptom management provided in an inpatient facility that cannot be managed in other settings.  GIP may be provided in the following settings:  a Medicare certified hospice inpatient unit, hospital, or a skilled nursing facility (SNF).  Additionally, GIP is intended to be short-term.

Some of the most significant results from the report include:

  • Medicare paid $1.1 billion for GIP in 2011, which was 8% of the total $13.7 billion paid for hospice care.
  • 58% of GIP stays were in hospice inpatient units, 33% in hospitals and 8% in SNFs.
  • $738 million was paid for GIP provided in hospice inpatient units, which was 67% of the total amount paid for GIP in 2011.
  • In total, 23% of hospice beneficiaries received GIP in 2011.
  • Hospices that used inpatient units provided GIP to 35% of their beneficiaries, which is 12% higher than the average to all hospice beneficiaries.
  • 33% of GIP stays were longer than five days.  More specifically, 11% of GIP stays were 10 days or more.
  • On average GIP stays in inpatient units were 50% longer than GIP stays in hospitals and 29% longer than GIP stays in SNFs.
  • 27% of Medicare hospices (953 of 3,585) did not provide any GIP in 2011.

The results raised several questions regarding the use of GIP.  A companion report will be published in the future addressing the appropriateness of hospice GIP provided or not provided to beneficiaries of claims from 2012.

To access the full report please go to the following link:  http://oig.hhs.gov/oei/reports/oei-02-10-00490.pdf.

HC Healthcare Consulting has extensive expertise in coding and billing compliance. Our staff includes certified coders, consultants Certified in Healthcare Compliance, and CPAs that are available to provide expert assistance with compliance programs.

DISCLAIMER:  This post contains only summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations given is general and specific questions should be directed to professional counsel.

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