Audit of Selected, High-Risk Medicare Hospice General Inpatient Services

OBJECTIVE

Medicare pays hospices a daily reimbursement rate for each day an individual is enrolled to receive the hospice benefit.  The reimbursement rate for hospice general inpatient (GIP) care is the second-highest daily rate that Medicare pays for hospice services.  GIP care is provided only for pain control or acute or chronic symptom management that cannot be managed in other settings.  It is intended to be short-term care.  For this audit, we will focus on claims for enrollees who were transferred to GIP care immediately after an inpatient hospital stay for a period during which the enrollee’s inpatient stay reached or exceeded the geometric mean length of stay for the assigned diagnosis-related group.  These hospice GIP claims are at high risk for inappropriate billing because GIP care may exceed an enrollee’s needs or may not be provided.  We will determine whether hospice providers that billed for GIP care complied with Medicare requirements.

TIMELINE

• June 15, 2023
  Announced
• Today
  Office of Audit Services In-Progress
• Est FY2026
  Estimated Fiscal Year for Project Completion

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