Hospice Insights: The Law and Beyond: Recent Episodes
Meg Pekarske
Tune in to Husch Blackwell’s hospice podcast with Meg Pekarske for conversations with industry innovators and fundamentals for navigating hospice law. In our commitment to monitoring updates and fostering learning, each episode delivers essential information clients need for best solutions in this changing healthcare sector.
CMS’s efforts to crush fraud in the hospice space have commanded the headlines and the attention of many. Less publicized efforts on behalf of hospices in the federal courts, however, have resulted in several rulings favoring hospices. In particular, the federal courts are starting to recognize that hospices deserve the benefit of the doubt when it comes to prognosticating a six-month life expectancy. In this episode, Bryan Nowicki talks with Joe Diedrich and Zaina Niles about those court cases and what they mean for the hospice community.
Hospice providers are no strangers to sensitive patient situations, but a subpoena or other third-party request for patient records can quickly raise complex legal and compliance challenges. In this episode, Husch Blackwell’s Bryan Nowicki and Taylor Crossley provide a practical roadmap for navigating those requests. They discuss the HIPAA framework governing legal process disclosures, the types of demands hospice providers often encounter, and how state privacy laws can affect the analysis—and offer guidance for avoiding common compliance pitfalls when responding to requests for patient information.
CMS revised the Medicare 60-Day Repayment Rule, changing how overpayments are identified. In this episode, Husch Blackwell’s Bryan Nowicki and Andrew Brenton analyze this change and how it affects the time frames applicable to internal investigations and repayment obligations. They also introduce a handy one-page summary of key deadlines.
Additional resources:
60-Day Repayment Rule
In hospice and home health, certain compliance problems can have a big impact on the organization’s bottom line—and ability to keep operating. Even seemingly minor issues can affect whether the organization will be fully paid for services it provided, subject to financial penalties, or even barred from participating in a payment program. To help home health agencies and hospices spot and prevent these problems, Husch Blackwell has created checklists of top compliance issues for hospice and home health, plus template spreadsheets for prioritizing and addressing each. In this episode, Husch Blackwell’s Bryan Nowicki, Andrew Brenton, and Josi Wergin discuss these tools and how you can use them.
Get the Hospice and Home Health Compliance Checklists
Access Husch Blackwell’s hospice and home health compliance checklists by emailing alyssa.bukolt@huschblackwell.com.
Hospice providers remain under heavy scrutiny, with prepayment audit and other audit activity on the rise. Unified Program Integrity Contractors (UPICs) historically conducted post-payment reviews. However, over the last six months, they have joined Medicare Administrative Contractors in reviewing claims on a prepayment basis. In this episode, Husch Blackwell’s Bryan Nowicki and Zaina Niles discuss this new type of UPIC audit and what your hospice can expect if a UPIC picks you.
Since September 2024, CMS’s Medicare Administrative Contractors have been conducting expanded prepayment reviews (also known as “EPRs” or targeted high-risk reviews) of existing hospice providers in Arizona, California, Nevada, and Texas. As of December 2025, hospices in Georgia and Ohio are also under the microscope. In this episode, Husch Blackwell attorneys Bryan Nowicki and Zaina Niles discuss how hospices can differentiate between EPRs and other audit types. You’ll also learn what to expect throughout the EPR process and strategies to overcome claim denials and other possible EPR consequences.
Since July 13, 2023, CMS has applied a Provisional Period of Enhanced Oversight (PPEO) to “new” hospice providers in Arizona, California, Nevada, and Texas. On December 30, 2025, CMS announced it was expanding PPEO to Georgia and Ohio. In this episode, Husch Blackwell attorneys Bryan Nowicki and Adam Royal discuss how these changes impact new (and not-so-new) hospice providers.
In this episode, Husch Blackwell’s Claire Postman joins host Bryan Nowicki to discuss CMS’s provisional period of enhanced oversight (PPEO) program that has now expanded to six states. From the basics to the fallout, they unpack who is subject to PPEO, what it involves, and how to avoid and handle the worst-case consequences of a PPEO gone awry.
Meg Pekarske has dedicated her professional life to the hospice community. In this episode, Bryan Nowicki interviews her about her years as a hospice attorney. Meg reflects on the characteristics of successful hospices and hospice leaders, current challenges, and why hospices should have hope for the future.
Welcome to a very special podcast! It’s special for many reasons. First, as a longtime admirer of Mettle Health’s visionary work supporting people through change and loss, Meg Pekarske was elated when co-founder Sonya Dolan and counselor Bridget Sumser said yes to being on the podcast. Second, a discussion of how we face endings seems fitting for Meg’s last episode as host of the Hospice Insights podcast.
Endings, whether a result of a diagnosis, aging, or other life changes, raise big questions related to identity, purpose, and meaning. Mettle Health offers emotional accompaniment for patients and caregivers working through not only the existential but practical questions brought about by illness, disability, and aging. The organization fills an essential gap left in our fragmented healthcare system.
In this passionate and compassionate conversation, we explore how Mettle Health’s unique model of care works, the advantages and challenges of running a largely “direct to consumer” healthcare business, how generational shifts may impact how we confront the challenges of serious illness in the future, the role and limits of technology in providing meaningful support and much more.
We’re confident the Hospice Insights podcast will live on in the capable hands of longtime colleague and frequent guest Bryan Nowicki. He will do an outstanding job, and Meg will still be around and looks forward to being a guest a time or two. She started this podcast more than six years ago as a way to connect and provide support to our colleagues and partners. Thanks as always for your loyal support!
For more information on the innovative work of Mettle Health, check out their website.
A common referral scenario involves hospital clinicians referring a dying patient to hospice. This circumstance gives rise to questions relating to hospice eligibility, the appropriate level of hospice care, and the expectation of the patient and the hospital. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki address these questions and provide insights into effectively managing this situation.
Additional resources:
Medicare Benefit Policy Manual Chapter 9 Excerpt - General Inpatient Care
Many hospices established their single entity corporate structure 40+ years ago and have left it largely untouched. But this too is worth a dust off especially as hospices are expanding into new geographies, new service lines, and affiliating with additional organizations. When done thoughtfully, an expanded corporate organizational chart does not need to cause painful complexity and administrative burdens. In fact, it may allow you to streamline governance, better protect your assets, and create operational efficiencies. Husch Blackwell’s Meg Pekarske and Adam Royal discuss what they are seeing across the country and key considerations when contemplating organizational changes.
The world of Medicare enrollment and the 855 may seem like a tangle of boring paperwork, but all that i-dotting and t-crossing is critical for avoiding Medicare deactivation and other unpleasant consequences. In this episode, Husch Blackwell attorneys Meg Pekarske and Andrew Brenton discuss the most common mistakes they see providers make related to the 855. You’ll learn which key individuals you should be sure to include on your 855 and why it is important not to wait for revalidation to make enrollment updates. Listen in for these and other practical tips on how to sidestep your next provider enrollment headache.
Additional Resources:
- CMS, Form 855A (Medicare Enrollment Application)
- Five Common Medicare Provider Enrollment Mistakes
You know those conversations that leave you feeling excited, hopeful, and ready to change the world? This is one of those conversations. In this episode, Husch Blackwell’s Meg Pekarske is joined by American Academy of Hospice and Palliative Medicine Fellow Dr. Bethany Snider. Dr. Snider shares how she developed a palliative care program that meets the needs of patients, payors, and her organization at-large. Their wide-ranging conversation covers alternative payment models, the importance of scale, the role of data analytics, and how to stay motivated in today’s regulatory environment.
CMS’s FY 2026 hospice final rule introduces significant changes to the face-to-face (F2F) attestation requirements starting October 1, 2025. All in all, the news is positive: while there is a new requirement for the F2F attestation to be signed and dated, the signed and dated F2F clinical note on its own can now serve as the F2F attestation.
In this episode, Husch Blackwell attorneys Meg Pekarske and Andrew Brenton share their thoughts on what the updated F2F attestation rules mean for hospice operators and weigh in on other components of the final rule, including CMS’s attempt at housekeeping by clarifying the types of hospice physicians who can certify patients.
Substandard quality care is the subject of survey citations and lawsuits, but it has also been used by the Justice Department to support false claim liability. While historically these cases were rare, a recent multi-million dollar settlement puts “worthless services” on the radar. Join Husch Blackwell’s Meg Pekarske and Jonathan Porter as they explore what the “worthless services” theory of liability is, when it has been used, and whether the recent settlement could signal a resurgence of these types of cases.
Increasing audit activity combined with certain decreasingly favorable audit appeal outcomes has resulted in hospices appealing audit results beyond the administrative law judge phase and into federal court. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the circumstances that gave rise to hospices taking their cases to federal court, how those cases are playing out, and what the future looks like.
Husch Blackwell’s Meg Pekarske is joined by Dina Yankelewitz, CEO of Vitalis Care, a technology company that is harnessing AI technology to reduce staff burden and allow more time for patient care. Dina shares her vision and passion for the hospice space, discussing how she applied her background in education and learning methods to inform not only what tools to develop but importantly how they work for the end user. Dina and Meg explore what AI is good at as well as its limits and why scheduling optimization, compliance, and reimbursement were the first areas Vitalis tackled. Dina shares her thoughts on what may be next for AI in the home care space, the hurdles she sees to adoption and change, and the opportunities for technology to enhance care, boost staff engagement, and give us all more time to do the work that is most meaningful.
Vitalis was built to solve the challenges hospices face every day — from missed units and clunky schedules to mileage fraud, billing gaps, and compliance headaches. Their tools help hospices predict end-of-life with improved accuracy; generate efficient, patient-centered schedules; track every mile with GPS-backed clarity; and simplify compliance with documentation support. To learn more about Vitalis Care visit their website at https://vitaliscare.ai/.
In an audit, election statement deficiencies can be costly. Auditors deny all claims covered by the problematic election statement, and those costs can multiply if more than one patient was affected. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, and Josi Wergin discuss common reasons auditors give for denying claims based on election statement deficiencies, and how hospices can improve their election statements to try to avoid them.
On May 12, 2025, the Head of the Criminal Division for the Department of Justice (DOJ) issued a memorandum outlining its enforcement priorities. In this episode, Husch Blackwell’s Meg Pekarske and Jonathan Porter break down what is new and not so new in DOJ’s announcement. They explore the memorandum’s revisions to the Voluntary Self-Disclosure Policy, its treatment on individual liability, and how whistleblowers may be impacted. Importantly, Jonathan shares takeaways on what hospices and their boards should do to stay vigilant.
Additional resources:
05.12.2025 DOJ Memorandum: Focus, Fairness, and Efficiency in the Fight Against White-Collar Crime
Hospice audits can have profound financial implications, particularly when the auditors use statistical extrapolation to identify an overpayment amount. The use of extrapolation runs across auditor types, including UPICs and the OIG, and can apply to Medicare and Medicaid.
In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, and Emily Solum discuss recent experiences and successes in dealing with statistical extrapolations, as well as what the future of extrapolation looks like.
Husch Blackwell’s Meg Pekarske is joined by colleague Kathleen Snyder, who has extensive experience in digital health and has been busy advising health care providers on how to safely implement artificial intelligence (AI) tools in their organizations. With AI holding so much promise for helping hospices gain efficiencies, reduce staff burdens, and improve the patient experience, we all need to jump into the future—but do so thoughtfully. This episode will help you with just that. We explore critical do’s and don’ts for AI and key infrastructure hospices should have in place when implementing any type of AI solution. Happy listening!
For hospices, unprecedented competition, enhanced oversight, and looming payment reform create business obstacles or growth opportunities, depending on your outlook. Your growth strategy shouldn’t be the same as your neighbor’s. Instead of following the herd, Husch Blackwell’s Meg Pekarske and Bryan Nowicki explore how to begin thinking about what should be on your strategic plan and the importance of bringing your board along with you.
Additional resources:
Hospice Past v. Present – Considerations
There has been a lot of buzz around psychedelics and particularly their potential usefulness in treating existential suffering at the end of life. Husch Blackwell was the first law firm in the country to establish a Psychedelics & Emerging Therapies practice group devoted to helping clinicians, researchers, and investors navigate the complex and difficult legal and regulatory issues involved in developing new therapies in this space.
In this episode, host Meg Pekarske is joined by the leaders of Husch Blackwell’s Psychedelics & Emerging Therapies practice group, Kimberly Chew, Karen Luong, and Natasha Sumner, who provide an overview of what psychedelics are, their legal status under federal and state laws, and liability considerations for clinicians. We also discuss the recent amicus brief they filed on behalf of nearly 30 end of life and palliative care providers in a case before the U.S. Court of Appeals for the Ninth Circuit. While there is a lot to digest here, we hope it is a helpful starting point for learning about this complex and evolving area.
Hospices that have gone through audits are familiar with certain recurring reasons why auditors deny claims. Two common reasons are the lack of support for a six-month prognosis and the insufficiency of the physician narrative. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a new twist on these kinds of denials, and how hospices can strengthen their documentation to try to avoid them.
CMS recently expanded its Provisional Period of Enhanced Oversight, or PPEO, in Arizona, California, Nevada, and Texas, and its enforcement activities nationwide appear more aggressive. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss these enhanced oversight efforts and ways, both structurally and operationally, for hospices to mitigate these risks.
It’s our first podcast of 2025 and we wanted to start the year out with some reflections. Join Husch Blackwell’s Meg Pekarske and Bryan Nowicki as they each share their biggest surprises and victories of 2024 and what is on their wish list for 2025. We hope you enjoy this episode and let us know what is on your wish list of podcast topics for 2025. Wishing you a happy new year!
The United States Supreme Court recently overruled decades-old precedent that favored an administrative agency’s interpretation of ambiguous statutes. This seismic shift in the role of the judiciary will affect every regulated industry, including healthcare and hospice in particular. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the implications of this decision in the hospice space.
Hospices that have been audited have to decide how to address any alleged overpayment identified by the auditor, whether through a voluntary repayment, recoupment, or applying for an extended repayment schedule. CMS recently identified updates to the Medicare Financial Management Manual relating to these options. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss those updates which, practically speaking, do not significantly change the existing options.
Additional Resources:
MM 11808 - Limitation on Recoupment of Medicare Overpayments
CR 11808 - Updating Chapter 3, Sections 200.5 - 200.8, Limitation on Recoupment; Medicare Overpayments Manual
In this episode, Husch Blackwell’s Meg Pekarske is joined by long-time hospice friend and industry guru Greg Grabowski. They turned the microphone on their usually private (but always lively) discussions on what’s going on in the wide world of hospice. To make it especially fun, they each prepared, but did not share prior to recording, their own list of what’s working and not working in hospice right now. Listen in to see how their observations match up.
UPIC activity is picking up, and the UPICs are reviving some old tactics. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki continue the discussion on these trends which include extrapolation, Medicaid nursing home room and board payments, patient interviews, and more. Meg and Bryan also describe some handouts they’ve developed to help hospices stay prepared for the inevitable audit.
UPIC activity is picking up, and the UPICs are reviving some old tactics. In this episode, Husch Blackwell's Meg Pekarske and Bryan Nowicki discuss these trends which include extrapolation, Medicaid nursing home room and board payments, patient interviews, and more. Meg and Bryan also describe some handouts they’ve developed to help hospices stay prepared for the inevitable audit.
A strong and engaged Chief Medical Officer (CMO) may be a hospice CEO’s most important asset. But what does a successful CEO/CMO relationship look like and how must it evolve to meet today’s challenges? In this episode we get to find out, as Husch Blackwell’s Meg Pekarske is joined by HopeHealth CEO Diana Franchitto and Dr. Edward Martin, CMO, whose trusted relationship has been instrumental to the organization’s success and clinical expansion. Whether it be forging new community partnerships or advocating for patients, Diana and Ed bring a wonderful compliment of strengths to advancing end-of-life care in their community. Listen in…be inspired!
Until recently, deactivation of a hospice’s Medicare provider number seemed like an action reserved for egregious conduct. But with law changes and an enhanced focus on enrollment, good hospices have found themselves facing a stop in their Medicare payments. Listen in as Husch Blackwell’s Adam Royal and Meg Pekarske discuss what has led to recent deactivations and how hospices can avoid the same fate.
It’s that time of year again when HIS and CAHPS non-compliance letters are sent out. While it can be an uphill battle, all may not be lost if you receive a notice of non-compliance. Join Husch Blackwell's Meg Pekarske as she talks with Jacob Harris, who shares insights on what matters in these appeals and how he helped so many hospices across the country over the last several years avoid detrimental rate cuts. The key takeaways are: 1. don’t assume nothing can be done and 2. it’s always worth exploring whether your facts may warrant pursuing an appeal.
It’s never a dull moment when you are a labor and employment lawyer these days! Beyond the steady rise in union activity (a topic of a prior podcast), the administration has issued two rules that are garnering much attention, and being contested in court, involving non-competes and when an employee can be considered exempt from overtime requirements. Husch Blackwell’s Tom O’Day joins host Meg Pekarske to discuss what these new rules mean for hospices and what you should be doing now to stay prepared. This is a great listen!
Additional Resources:
Federal Trade Commission (FTC) Non-Compete Clause Rule
Department of Labor (DOL) Rule on Overtime Exemptions
The Impact of the FTC’s Ban on Noncompete Agreements in the Health Care Industry
Compliance gets a dust off with the new General Compliance Program Guidance released by the federal Office of the Inspector General (OIG) in November 2023. While there is a lot to digest, Husch Blackwell’s Josi Wergin and Natasha Sumner join host Meg Pekarske to break it down highlighting important differences from past guidance and key implementation considerations. They also read the tea leaves on what to expect in forthcoming hospice specific compliance guidance. An important listen for everyone in hospice!
As member substitutions become an increasingly common method of affiliation for nonprofit hospices, hospices may encounter various opportunities for affiliation. Join Husch Blackwell’s Meg Pekarske and Adam Royal as they discuss what has—and hasn’t—worked in member substitutions, and issues to spot early in a transaction to determine its feasibility.
In this episode, Meg Pekarske is joined by Jody Rudman, the leader of Husch Blackwell’s White Collar, Internal Investigations & Compliance group, where they explore the enforcement and privacy issues surrounding artificial intelligence. Jody shares insights on the most common types of cybersecurity issues and how to prevent them. A cutting-edge conversation to help ground you in this emerging area.
Recovery Audit Contractors (RACs) have played a relatively limited role in the hospice space, often overshadowed by UPICs, SMRCs, and Center for Program Integrity audits. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki talk about a recent wave of record requests issued by a RAC named Performant that focus on GIP and Continuous Home Care, and some ideas about how to respond.
Hospice Targeted Probe and Educate reviews (TPEs) continue to be initiated all over the country. That means it’s time to check in with Husch Blackwell's Hospice team on the latest developments. In this episode, Meg Pekarske and Bryan Nowicki discuss a new TPE topic and describe both the time-tested and emerging strategies hospices can use to respond to these reviews.
It came as a surprise to our team when we learned that the Centers for Medicare & Medicaid Services (CMS) was ending the hospice component of Value-Based Insurance Design (VBID) on December 31, 2024. Upon learning this, Husch Blackwell’s Meg Pekarske contacted Chris Comeaux, the president and CEO of Teleios Collaborative Network, to see if he wanted to share his thoughts on this unexpected turn of events and what may be on the horizon. This is a forward-looking conversation where we explore how the lessons learned can galvanize new advocacy on the best ways to care for patients with advanced illnesses.
Five years ago, the U.S. Department of Health and Human Services Office of Inspector General (OIG) initiated audits of 13 hospices and published its findings in 13 separate reports. It appears that the OIG is at it again, as multiple hospices recently have received “engagement letters” from the OIG with directions to produce medical records for 100 randomly selected claims. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss these OIG audits, strategies for responding, and their implications for the hospice community.
The owner of a Louisiana hospice was indicted and then convicted of healthcare fraud. How did that happen? In this episode, Husch Blackwell's Meg Pekarske and Jonathan Porter talk about how a routine audit led to a whistleblower complaint by a hospice employee, which then led to the hospice owner’s criminal conviction following trial in November 2023. Most importantly, the pair discuss how other hospices can avoid that fate.
Additional resource:
- Jury Convicts Hospice Owner for Defrauding Medicare
In this episode, Husch Blackwell’s Meg Pekarske is joined by friend and industry veteran Kim Skehan. In this wide-ranging conversation, they explore not only the recent survey reforms but the ways in which Kim’s decades of work as a survey consultant to hospices and home health agencies shape how she approaches her new role leading accreditation at CHAP. Kim’s perspective is truly unique. This is a must listen for everyone looking to successfully navigate the survey process.
The hospice industry saw many regulatory changes in 2023. In this episode, Husch Blackwell's Meg Pekarske, Andrew Brenton, and Adam Royal discuss some of the main regulatory changes from 2023 and what hospices should expect in 2024.
Traditional hospice transactions are receiving increased regulatory scrutiny and headwinds. Amidst these challenges, many hospices are considering management services organizations as an alternative to traditional transactions. In this episode, Husch Blackwell's Meg Pekarske and Adam Royal discuss how management services organizations can help hospices achieve economies of scale while minimizing regulatory scrutiny.
An effective compliance program is the bedrock of any successful healthcare organization and behind every successful compliance program is a trusted relationship between the Compliance Officer and CEO. In this episode, Husch Blackwell’s Meg Pekarske is joined by Avow Hospice’s CEO, Jaysen Roa, and its Compliance Officer, Kerri Ervin, who share how they built their relationship and how it has evolved over time. Jaysen and Kerri provide insights on what it means to have a collaborative relationship, how they see the big picture and ways to navigate different perspectives. There are so many good nuggets in this conversation like “relentless reliability” that remind us trust is earned, leadership is action, and success is a reflection of the quality of our relationships.
Centers for Medicare & Medicaid Services (CMS) devised a “Special Focus Program” to identify poor performing hospices and help them improve through more frequent surveys and technical assistance. CMS would also impose enforcement remedies and fines to further incentivize improvement. How to identify poor performing hospices, however, has sparked concern among the hospice community. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the Hospice Special Focus Program and what hospices can expect from that program as it rolls out in 2024.
For a variety of unfortunate reasons, some hospices found themselves facing a 4% rate reduction for non-compliance with either Hospice Item Set (HIS) or Consumer Assessment of Healthcare Providers & Systems (CAHPS) requirements. For the third year in a row, the Husch Blackwell hospice team successfully advocated that the penalty not be imposed on its clients and CMS agreed! In this episode, Husch Blackwell’s Meg Pekarske and Jacob Harris share more about how they achieved these thrilling results. This is a good listen and reminder for all of us that good advocacy can make a difference and CMS does keep an open mind.
CMS has criticized hospices for underutilizing general inpatient care (GIP) but has also specifically targeted GIP claims for audit and medical review. In addition to CMS’s standard tools for reviewing GIP claims, such as UPIC audits and TPEs, the OIG is now getting involved with a GIP audit of its own. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the divergent approaches to GIP care and what this may mean for the hospice benefit.
Join Husch Blackwell’s Meg Pekarske and Wendy Arends as they explore the new draft Merger Guidelines and what enforcement may look like in the future. Given the number of hospices looking to consolidate through mergers, joint ventures, and other types of affiliations, you won’t want to miss this episode.
While not new, the number and scope of Targeted Probe and Educate (TPE) reviews have soared to new heights. At the same time, more hospices are facing the uncomfortable position of moving to a second and sometimes third round of review. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki share how they have successfully navigated clients through the TPE process. In addition, they offer tools and tips for staying organized while advocating for your organization throughout the process.
In the midst of consolidation and restructuring among hospices, the Centers for Medicare & Medicaid Services (CMS) is scrutinizing initial enrollments and changes in ownership and management. In this episode, Husch Blackwell’s Meg Pekarske and Adam Royal discuss new and proposed changes to CMS’s provider enrollment screening and why it matters to hospices.
It’s been hard to keep track of all the new changes related to government oversight of hospices. This growing list now includes an expansion of the 36-month rule to hospices, which will limit the frequency that hospices can change ownership. There are important exceptions to the rule that all hospices will need to closely consider when evaluating all types of organizational changes, including traditional acquisitions and other types of consolidations. Listen in as Husch Blackwell’s Meg Pekarske and Ragini Acharya share their insights.
Hospices have been the target of increased government scrutiny in 2023, and the Centers for Medicare and Medicaid Services (CMS) is planning to take further aim in 2024 through surveys. Join Husch Blackwell’s Meg Pekarske, Emily Solum, and Erin Burns as they talk about a cautionary survey tale and proposed changes to the hospice survey process, including the introduction of an informal dispute resolution (IDR) process, and a special focus program for poor performing hospices.
Hospices are increasingly looking to buy, consolidate, or merge to achieve administrative efficiencies and expand operations for growth. A common approach among nonprofit hospices is to combine through a member substitution. In today’s episode, Husch Blackwell’s Meg Pekarske and Adam Royal discuss key considerations and strategies for hospice member substitutions.
A study published by NORC at the University of Chicago, a nonpartisan research organization, concluded that the Hospice Benefit saved Medicare $3.5 billion in 2019. The data behind that figure, and the study’s related findings, show that the value of the Medicare Hospice Benefit appears to be at odds with CMS’s regulatory priorities. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki dig into the numbers, talk about the NORC study, and its potential impact on hospices and the Hospice Benefit.
In the five-step audit appeals process, hospices often stop their appeal efforts after finding success at the third step, a hearing before an administrative law judge (ALJ). However, if an ALJ issues an unfavorable decision, the hospice still has recourse. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki talk about dealing with an unfavorable ALJ decision, including how to evaluate the strengths, weaknesses, costs, and benefits of pursuing the remaining steps of the appeal process.
In this episode, Husch Blackwell’s Meg Pekarske and Jonathan Porter, a former federal prosecutor, discuss takeaways from the recent American Bar Association’s Annual National Institute on Health Care Fraud. Most importantly, they will explore what the hospice industry can expect after hearing the remarks of Lisa Miller, the Department of Justice’s (DOJ) Deputy Assistant Attorney General who oversees the Criminal Fraud Section. According to Miller, data has shown an increase in costs to the Medicare program resulting from claims for hospice care. Therefore, combating health care fraud is going to be a top priority for the DOJ. Be sure to tune in for this important episode. You won’t want to miss it.
Hospice professionals are often left wondering how the Centers for Medicare and Medicaid Services (CMS) and other government entities identify enforcement priorities. They also seek understanding about the subsequent steps taken for audits and False Claims Act investigations. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, and the hospice team’s newest member, former federal prosecutor Jonathan Porter, talk about the reasons and methods behind government enforcement efforts, and how hospices should respond to them.
Audits that employ statistical extrapolation can turn a handful of claim denials into a liability of hundreds of thousands or millions of dollars. After years of relative quiet, the statisticians are back. The Centers for Medicare and Medicaid Services (CMS) also modified the rules relating to extrapolation in audits. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki review the latest in extrapolation and how the new rules will affect audits going forward.
Earlier this spring, as part of its annual rulemaking process for hospices, the Centers for Medicare and Medicaid Services (CMS) issued several important regulatory proposals. In addition to the yearly update in hospice per diem rates, the proposed rule clarifies the end dates for hospices to use telehealth and other technologies to provide remote care. The rule also contains a rather unpleasant surprise: CMS’s proposal to require, as a condition of payment, that all certifying physicians be enrolled in or validly opted-out of Medicare. Listen in as Husch Blackwell’s Meg Pekarske and Andrew Brenton offer their quick takeaways and insights into the latest of CMS’s rulemaking efforts.
The HIPAA regulations require that covered entities enter into agreements with business associates who provide certain services for the covered entity involving the receipt, use, or disclosure of protected health information. In working with hospices throughout the years, we have found that many hospices have business associate agreements with nursing homes, vendors, and other providers where a business associate agreement is not required because neither party is actually a business associate of the other. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton discuss when a business associate agreement is and is not required, so that hospices can confidently comply with the law while focusing on what matters most: delivering high-quality end-of-life care.
The U.S. Department of Health and Human Services’ Office of Inspector General (OIG) reported in November 2022 that many providers are not complying with Medicare’s billing rules for advance care planning services. In large part, the OIG’s findings centered around providers failing to document separately for time spent on advance care planning versus time spent on concurrent services provided during the same patient visit. In this episode, Husch Blackwell’s Meg Pekarske, Andrew Brenton, and Zaina Niles break down the OIG report and what the key takeaways are for hospices.
Payment suspension and overpayment extrapolation are among the most extreme and effective enforcement tools available to the Centers for Medicare and Medicaid Services (CMS) and its auditors. However, even these measures can be overcome. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, and Emily Solum talk about our hospice team’s latest encounter with payment suspension and extrapolation. Spoiler alert—it has a happy ending!
The Centers for Medicare and Medicaid Services (CMS) unexpectedly proposed a rule change that could have a significant impact on how hospices investigate compliance issues and take remedial action. The rule change directly affects potential liability under the federal False Claims Act. Therefore, it is critical that hospices understand this change so they can take steps to mitigate risk and financial exposure. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki talk about this proposed rule change and how hospices may need to change their approach to compliance investigations and activities.
The Home Care 100 Leadership Conference is an annual gathering of top leaders and innovators in the hospice and home health community. Presentations and informal discussions address the current state of the industry and what will drive future survival and success. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Emily Solum talk about their participation in this year’s conference, what the future holds for hospices, and how to avoid getting left behind in the continually evolving hospice community.
While direct patient billing may be less common for hospice patients than for patients receiving hospital or other types of care, there are aspects of the No Surprises Act and its implementing regulations that are important for hospices to understand. In this episode, Husch Blackwell’s Meg Pekarske, Noreen Vergara and Andrew Brenton break down how the No Surprises Act applies to hospices. They also share key tips for hospice compliance with these new federal rules prohibiting surprise medical bills.
Recently, there has been an uptick in contractor participation at the ALJ stage of hospice audit appeals. This development poses unique challenges and new advocacy opportunities for providers. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki, Emily Solum and Zaina Niles about how hospices can prepare for and get the most out of contractor appearances at ALJ hearings.
The Department of Health and Human Services Office of the Inspector General (OIG) recently released a report detailing its evaluation of CMS’s primary fraud, abuse and waste investigators—the Unified Program Integrity Contractors (UPIC). In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki about the OIG’s report, what it reveals about UPIC activities, and what it means for the future of UPIC audits.
The hospice physician plays an enormously critical role in hospice operations, from certifying patients as terminally ill to being the hospice’s representative in the community. Just as the physician’s role is critical, so too is the physician’s contract with the hospice. When it comes to contracting for a medical director’s or other hospice physician’s services, there are a variety of pitfalls to avoid and legal considerations to keep in mind. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton share their key tips for structuring hospice physician agreements.
The hospice certification of terminal illness is one of the documents most scrutinized by Medicare contractors, and it is of critical importance since an invalid certification can impact Medicare payment for the patient’s entire 90 or 60-day benefit period. If overlooking any of the multitude of certification requirements is human, then building redundancies into your certification documentation to avoid claim denials or a repayment obligation is divine. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton share key ideas for putting yourself in a more favorable position in the event your best-laid written certification plans go awry.
Husch Blackwell’s Meg Pekarske is joined today by Mary Kay Tyler, Chief Quality and Compliance Officer of Hospice of the Western Reserve, who shares strategies for achieving the elusive goal of improved clinical documentation. As Mary Kay discusses, you start with what can make the biggest impact. For general inpatient care (GIP), that is often physician and nurse practitioner (NP) documentation. Meg and Mary Kay discuss how she leveraged her electronic medical records (EMR), fostered buy-in, cultivated accountability, and remembered to listen throughout the process. We encourage you to take notes—you won’t want to miss any of these helpful tips.
Hospices are increasingly looking to buy, consolidate or merge to achieve administrative efficiencies and expand growth opportunities. Transactions between hospices present unique regulatory challenges that shape corporate and transactional structures, and often require looking beyond the client’s organizational charts. Join Husch Blackwell’s Meg Pekarske, Adam Royal and Erin Burns as they discuss key considerations and strategies in hospice transactions.
COVID-19 remained a substantial obstacle to hospices’ efforts to comply with quality data reporting obligations in 2021. Those challenges resulted in a number of hospices receiving notices of a 2% Medicare payment reduction in July 2022. We appealed those notices and won! In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Jacob Harris talk about those appeals, the keys to success and what to expect next year.
The hospice election may be the single most important document for hospices since an invalid form can impact payment for a patient’s entire stay. Especially in light of a recent rise in Medicare claim denials related to the election, revisiting your form now could save you later in time and money. In this episode, Husch Blackwell’s Meg Pekarske, Emily Solum and Andrew Brenton share some key tips for avoiding common election denials—and the headaches and sleepless nights that come with them.
For the last two-and-a-half years, hospices and other providers have been using billions in Provider Relief Fund (PRF) payments to prepare for, respond to and recover from the COVID-19 pandemic. The Office of Inspector General (OIG) has begun its nationwide audit of providers’ use of PRF payments, removing any remaining doubt as to whether these payments came with very significant strings attached. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Andrew Brenton share their experiences regarding the purpose and nature of the OIG audit and offer practical takeaways for hospices.
Husch Blackwell’s Meg Pekarske is very excited to be joined today by Jaysen Roa, President and CEO of Avow Hospice in Naples, Florida. Jaysen is a leader of action who is finding new ways to approach and solve the challenges facing the hospice industry. He is leveraging technology to provide better and more responsive hospice care at the end of life. He is also collaborating with other hospices through the formation of Synthase Collaborative to improve efficiencies and work with new payors. Jaysen is a wonderful example of a how a holistic mindset isn’t just reserved for bedside care but can be the foundation for creative problem solving, whether that be staffing challenges or pursuing new lines of business. Thank you so much for listening and we hope you enjoy the conversation. If you like our podcast, please subscribe and rate us!
In this episode, we continue our discussion of home health enforcement trends, focusing on other audits currently troubling agencies. These include audits from Unified Program Integrity Contractors (UPIC), Supplemental Medical Review Contractors (SMRC) and the Targeted Probe and Educate (TPE) program by the Centers for Medicare and Medicaid Services (CMS). As on the hospice side, these audits can be an administrative burden and should be taken seriously. Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Erin Burns talk about some of the types of home health audits they are currently seeing and strategies for response and appeal.
In a prior podcast, we alerted you to the Office of Inspector General’s (OIG) nationwide review of hospice beneficiary eligibility. The OIG has begun sending out requests for records to hospices across the country. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Erin Burns discuss what hospices can expect and what they should do.
Each July, the Medicare Administrative Contractors issue notices of a 2% Medicare payment reduction to those providers who did not meet quality data reporting requirements. Those notices have been sent. In this episode, Husch Blackwell’s Meg Pekarske and Jacob Harris talk about the issues providers faced in 2021 and how to pursue an appeal of the 2% payment reduction.
As many hospices continue to diversify into new business lines, staying abreast of enforcement trends outside of hospice is more important than ever. Home health in particular, is receiving significant government scrutiny. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki and Erin Burns about a new round of home health audits being conducted by the Office of Inspector General for the Department of Health and Human Services.
When confronted with a complaint, allegation or event that implicates a potential Medicare overpayment, hospices have an affirmative duty under the federal 60-day repayment rule to conduct an investigation and refund any overpayment. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton share tips and tools for conducting internal investigations and determining when an issue implicates payment.
The core of most hospice audits has been, and continues to be, whether the medical record supports the patient’s hospice eligibility. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki and Zaina Niles about strategies for showing how a medical record supports a patient’s six-month prognosis.
The Centers for Medicare & Medicaid Services (CMS) has recently started mailing letters inviting physicians to one-on-one training sessions about the Medicare hospice benefit. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Claire Postman talk about what these training sessions involve, why CMS is conducting them, and how physicians and hospices can respond.
Unified Program Integrity Contractor (UPIC) audits are on the rise, and the UPICs are embracing the full array of enforcement tools at their disposal. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the ways that UPICs can put pressure on hospices and how hospices can respond.
Strategic Restructuring for the Future: Exploring How Hospices Are Using Joint Ventures, Mergers and Acquisitions, and Service Diversification to Transform
Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.
Today's Episode | Exploring Upstream Revenue Opportunities for Hospices
In this era of disruption and market consolidation, the talk of the town is how hospices can make strategic pivots to expand their geography, diversify the scope of their services to get further upstream, and otherwise be more attractive to payors, including managed care plans. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton unpack some key upstream care revenue opportunities and release a new tool created for hospices to begin evaluating them.
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Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode | Audit Overlap: Connections and Contradictions Among Audits, Auditors and What to Do About Them
As audit activity escalates, hospices are getting increasingly familiar with the alphabet soup of audits and auditors, including OIG, UPIC, CMS, CPI, SMRC, MAC, TPE and more. Unfortunately, there are times when hospices are dealing with multiple audits at the same time. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the increasing prevalence of simultaneous audits, what it might mean and what to do about it.
Strategic Restructuring for the Future: Exploring How Hospices Are Using Joint Ventures, Mergers and Acquisitions, and Service Diversification to Transform
Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.
Today's Episode: Insights on Building a Hospice Network From the Ground Up - A Conversation With Mike Milward, CEO of the California Hospice Network
As we explored in our podcast on June 30, 2021, there is no one way for hospices to collaborate and position themselves for value-based care. In today’s episode, Husch Blackwell’s Meg Pekarske has the great pleasure to be joined by Mike Milward, CEO of the California Hospice Network (CHN), who shares his firsthand insights on creating an innovative network model in California.
They explore how this idea became a reality and how that reality has evolved with time. Mike invites us to see how independence and control can work within an integrated model. With so many insights shared in this episode, you must listen. Enjoy!
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: Beyond Part D, OIG Scrutinizes the Hospice Industry to the Tune of $6.6 Billion
In a follow-up to its recent reports on billing outside the hospice benefit for drugs and durable medical equipment (DME), the Office of Inspector General’s (OIG) new data report identifies billions being billed to Medicare Part A and B for hospice patients. What lies behind the headline?
In this episode, Husch Blackwell’s Meg Pekarske, Andrew Brenton and Erin Burns unpack the OIG’s analysis and its critical shortcomings. They throw in some food for thought on what changes the industry might expect in light of the growing concerns related to the unbundling of care.
Welcome to an inspiring conversation on how story can help us reconnect with mission, staff and communities. As hospices face unprecedented staffing shortages and a burnt-out workforce, a key to thriving may be to re-engage with our human essence, which can be found through story. Today’s guest, Dr. Bertice Berry, PhD, explains humans are hardwired for story—it is how we connect, reflect and grow. So how do we use storytelling as a leadership tool? The Institute for Story’s upcoming conference Reinvented Through The Power And Science Of Story intends to help leaders do just that.
Today, Husch Blackwell’s Meg Pekarske has the great pleasure to be joined by two of the founders of the Institute for Story, Jamey Espina and Dr. Berry, who is also a best-selling author and top change management speaker, along with Hospice Savannah CEO, Dr. Kathleen Benton, DrPH, MA, who has found success in using story as a leadership and engagement tool. Their lively discussion explores the role story can play in connecting to ourselves and others, and how it may be a superpower when leading and supporting communities through difficulty. We believe this is a life-affirming and energizing conversation, and we hope you enjoy it!
For more information and to register for the Institute for Story Conference to be held in Savannah, Georgia on April 24–26, please visit their website at instituteforstory.com.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: The OIG’s Impending Review of Nationwide Hospice Eligibility Demands a Robust Response From Hospices
The Office of Inspector General (OIG) recently announced that its 2022 work plan for hospices will include a nationwide review of hospice beneficiary eligibility. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss what led to this latest effort by the OIG, what hospices can expect and what they should do.
Our hospice team has been fielding questions from hospices across the country on administering COVID-19 vaccination requirements. In this episode, Husch Blackwell’s Meg Pekarske is joined by colleague Jessica Brown, where they discuss the most pressing vaccination issues and how to navigate them. They explore strategies for handling vendors, the role unvaccinated staff can have in direct patient care, obligations to require boosters and what enforcement may look like. This episode contains many helpful insights, and you won’t want to miss it. Happy listening!
Providing hospice care to vulnerable individuals can embroil hospices in a variety of unwanted situations. The emotions surrounding the death of a loved one can cause families and caregivers to question the kind of care provided. These sensitive circumstances can also lead to disputes between family members, or between the family and other providers or facilities, with the hospice often stuck in the middle.
In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Jake Harris discuss what hospices should do when confronted with these situations.
Hospices’ unique regulatory and business environment impacts how they contract with and relate to other private entities. In this episode, Husch Blackwell’s Meg Pekarske, Bryan Nowicki and Jake Harris discuss the many kinds of hospice-related contracts and contract-dispute matters they have worked on, and how their clients benefitted from their in-depth knowledge of hospices.
Hospices and the False Claims Act Series
The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.
Today's Episode: Proposed Amendment Would Increase Liability Risk
The False Claims Act is a powerful enforcement tool used to go after those who defraud the government. Unfortunately, the wide net cast by the False Claims Act can lead to extremely negative consequences for upstanding hospices. In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss a proposed amendment to the False Claims Act that would widen that net even further, and describe the mounting opposition to this legislation.
Strategic Restructuring for the Future: Exploring How Hospices Are Using Joint Ventures, Mergers and Acquisitions, and Service Diversification to Transform
Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.
Today's Episode: Think Before You Sign - Five Key Insights for VBID and Managed Care Contracts
Private payor contracts will define future revenue for hospices. Whether it be Medicare Advantage Value-Based Insurance Design (VBID) contracts for hospice services or for upstream non-hospice services (palliative and supportive care), the rules of the road will be defined by what you negotiate with payors. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton unpack five takeaways learned in working with hospices on their managed care contracts. We hope you enjoy the conversation and thanks for listening.
What is the latest on vaccine mandates? In this episode, Husch Blackwell's Meg Pekarske is joined by colleague Tom O’Day to discuss the newly released OSHA and CMS rules. They'll uncover the surprises, discuss how to implement the requirements and analyze the challenges that may be on the horizon for hospices. Tune in to this lively and helpful conversation.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: Hospice Audit Series - Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part II
In Part II of our two-part series on ALJ hearings, Husch Blackwell’s Meg Pekarske unpacks strategies for winning with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and who should be on your team. They also share tips for overcoming the most common hurdles to winning, and the hidden surprises they have found in ALJ decisions. We hope you enjoy this engaging conversation!
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: Hospice Audit Series - Insights for Winning at Administrative Law Judge (ALJ) Hearings, Part I
In this two-part series, Husch Blackwell’s Meg Pekarske unpacks strategies for winning at ALJ hearings with colleagues Bryan Nowicki, Emily Solum and Erin Burns. They explore what it means to be well-prepared and who should be on your team. They also share tips for overcoming the most common hurdles to winning, and the hidden surprises they have found in ALJ decisions. We hope you enjoy this engaging conversation!
In this episode, Husch Blackwell's Meg Pekarske chats with colleagues Bryan Nowicki and Jacob Harris, who share what happened with the Hospice Item Set (HIS) noncompliance letters. You have to listen—did hospices win or lose?
Strategic Restructuring for the Future: Exploring How Hospices Are Using Joint Ventures, Mergers and Acquisitions, and Service Diversification to Transform
Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.
Today's Episode: Putting a Plan Into Action - A Conversation With Gloria Brooks on Building End-of-Life Partnerships
As many hospices begin the hard work of exploring how collaboration can benefit their organizations, it can be helpful and inspiring to hear how others have walked the same path. In today’s episode, Husch Blackwell’s Meg Pekarske talks with Gloria Brooks, who traveled this road as she led Arbor Hospice and its board through its affiliation with Hospice of Michigan. Gloria provides great insight into what it takes to make transformational change and successfully navigate through the issues that matter. She now helps hospices across the country build end-of-life partnerships through her consulting business called G. Brooks & Associates. Thank you for listening and we hope you enjoy the conversation.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: A Beginning and an End from CMS - TPE Resumes While QIC Demonstration Ends
In today’s episode, Husch Blackwell’s Meg Pekarske talks with team members Bryan Nowicki and Erin Burns about two recent developments in the hospice audit arena. First, the Centers for Medicare & Medicaid Services (CMS) announced that Targeted Probe and Educate (TPE) audits would resume on September 1. Second, on December 31, 2021, CMS’s popular Qualified Independent Contractor (QIC) Telephone Demonstration is set to end. Meg, Bryan and Erin share insights on TPE and the QIC Demonstration as well as potential actions for hospices to take related to both.
By October 1, 2021, hospices will need to update their election addendum form to address a change made by the Centers for Medicare & Medicaid Services (CMS) in the final rule. The government has provided much-needed clarification and flexibility to certain aspects regarding the addendum. When should hospices provide the addendum to patients? What should hospices do if a patient refuses a signer’s discharge prior to signing the addendum?
In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton answer these questions and discuss other key changes related to the addendum announced in the final rule.
After exploring the attributes of a well-functioning board, in this episode we delve into common practices and tendencies that can limit board performance. Whether it be factioning, side conversations or confidentiality leaks, there are activities that get in the way of good governance.
Husch Blackwell’s Meg Pekarske and Stephanie Kaiser talk through how to help leaders identify these roadblocks and institute practical strategies to navigate them. We hope you enjoy this insightful conversation filled with helpful takeaways to improve participation and engagement of your full board.
In this episode, Husch Blackwell’s Meg Pekarske and Jacob Harris unpack what may be behind the Hospice Item Set (HIS) noncompliance letters that many hospices believe they have erroneously received. These letters indicate hospices have not achieved compliance with the HIS reporting requirement. Meg and Jacob explore how the Centers for Medicare & Medicaid Services’ (CMS) temporary 6-month reporting exemption may have unexpectedly impacted some hospices. They also discuss the importance of using the appeal process to dispute noncompliance. Please tune in to learn more.
Hospice and the False Claims Act Series
The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this 3-part series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.
Today's Episode: Success in False Claims Act Lawsuits
In this third episode of the Husch Blackwell Hospice Team’s “Hospice and the False Claims Act” series, Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss the process and path of a False Claims Act (FCA) lawsuit. FCA cases are a test of endurance as much as they require expert marshalling of facts and law. The Hospice Team gives the insider’s view of an FCA lawsuit, including how hospices and their attorneys work together to identify strengths and weaknesses, manage expectations and develop a winning strategy.
Strategic Restructuring for the Future: Exploring How Hospices Are Using Joint Ventures, Mergers and Acquisitions, and Service Diversification to Transform
Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.
Today's Episode: Succeeding in Value-Based Care - How Hospices Can Collaborate Through Network Models
Today, Husch Blackwell’s Meg Pekarske is joined by the newest member of our Hospice & Palliative care team, Noreen Vergara, where they discuss different ways hospices can come together to succeed in the value-based care landscape. They explore a continuum of options from messenger-model networks to networks that are clinically and financially integrated all the way to common ownership through merger or acquisition. While there is no one-size-fits-all approach, collaboration can be a fresh way to create operational efficiencies, streamline costs, expand geographic reach and benchmark quality, all of which are critical to enhancing payor relationships. We hope you enjoy this rich conversation.
After nearly half a year of silence, the U.S. Department of Health and Human Services finally provided direction on when providers need to submit Provider Relief Fund (“PRF”) compliance reports. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton discuss this and other PRF developments, including new deadlines by which providers must use their PRF payments and guidance on how to return those portions of PRF payments that remain unused.
Privacy Series
In this series, we will explore all things privacy. From HIPAA breaches, to updates on the information blocking rule, to privacy enforcement trends, hospices will learn what they need to know to stay current in this evolving area of law.
Today's Episode: HIPAA Breaches - When It Is, and When It Is Not a Breach
In today’s episode of our Hospice Privacy Series, Husch Blackwell’s Meg Pekarske is joined by colleagues Wakaba Tessier and Erin Burns, who share insights on the ins and outs of HIPAA breaches. They break down what a HIPAA breach really is, the types of breaches most often experienced by hospices and what to do when you think you have discovered a breach.
In today’s episode of Hospice Insights, Husch Blackwell’s Meg Pekarske shares her recent wide-ranging conversation with Dr. Kathleen Benton of Hospice Savannah, where they explore how good business planning starts and ends with good questions and strong ethics.
Applying a “buy local” philosophy to healthcare, Kathleen sees her future intwined with that of her community in that their needs define her organization’s business plan. Whether it be expanding palliative care opportunities, opening a vaccination center or deepening existing local partnerships, Kathleen brings a passion and purpose to what she does and sees opportunities beyond what has traditionally been in the “hospice lane.”
Kathleen’s wit and good humor are contagious, and so are her enthusiasm for her work and her trust in the questions that lead us forward. We hope you enjoy the conversation.
Hospice and the False Claims Act Series
The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this 3-part series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.
Today's Episode: Successful Approaches to Government Investigations
In this second episode of the Husch Blackwell Hospice Team’s three-part “Hospice and the False Claims Act” series, Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss the precursor to almost every False Claims Act (FCA) lawsuit—the government investigation. Before an FCA case proceeds in court, the government typically conducts a thorough investigation. FCA cases can be won or lost at this stage, and how hospices respond to such investigations can set the stage for future success (if done properly) or future problems and liability (if mishandled).
The Hospice Team discusses the ways in which the government investigates hospices in the FCA context and provides tips for a successful response to an investigation.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: How are Hospices Faring at ALJ Hearings?
After waiting years, hospices are getting their “day in court.” How are hospices faring? In this episode, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Emily Park, who share insights on what it takes to be successful before an Administrative Law Judge (ALJ). They discuss what is important to spend time on and what can be a distraction, as well as tips for how to stay focused on what matters. We hope this conversation provides you with new ideas on how to approach your next hearing.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: CMS Program Integrity Audits Are Back!
In this episode, Husch Blackwell’s Meg Pekarske and Bryan Nowicki discuss the new wave of CMS Center for Program Integrity (CPI) audits that have been issued during the past couple weeks. These CPI audits remain focused on long length of stay patients and typically involve hundreds of claims valued at over $1 million. As Meg and Bryan explain, these audits may signal a new approach to auditing by CMS, and it is important for hospices to refine their response and appeal strategy accordingly.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: The Second Guessing of Billed Hospice Physician Visits
Today, Husch Blackwell’s Meg Pekarske is joined by colleagues Bryan Nowicki and Erin Burns to discuss the recent denial of physician visits. Over the last several months, a number of auditors have begun questioning the medical necessity of billed physician visits, claiming the physician services were solely administrative in nature. They break down the criteria auditors appear to be using, what this means for hospices and how hospices can avoid such denials. We hope you enjoy the conversation.
Hospice Audit Series
Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.
Today's Episode: Spring Audit Bloom—Medicaid UPICs and MAC ADRs
Today, Husch Blackwell's Meg Pekarske is joined by colleagues Bryan Nowicki
and Erin Burns to discuss the recent flurry of audit activity, specifically the
re-emergence of UPIC Medicaid audits and MAC post-pay ADRs. We will talk about what these requests look like, what we think it means and strategies for how hospices should respond.
Hospice and the False Claims Act Series
The False Claims Act (FCA) is the government’s most serious weapon to combat fraud in the healthcare community, and hospices are increasingly the target of FCA investigations and lawsuits. The United States Supreme Court is, for the first time, considering FCA cases involving hospices and certifications of terminal illness. Moreover, the relief funds disbursed by the government to hospices as a result of the COVID-19 pandemic add to the existing and substantial number of bases of potential FCA liability for hospices. Aggressive government investigation, enforcement efforts and increased whistleblower activity is coming. Hospices can and should prepare for this new environment. In this 3-part series, Meg Pekarske talks with Husch Blackwell attorneys Bryan Nowicki, Jody Rudman and Brian Flood about emerging issues involving hospices and the FCA. Bryan, Jody and Brian will share their experiences as seasoned litigators in FCA cases to help hospices understand the FCA trends affecting hospices, and provide practical guidance to help hospices prepare themselves to preempt, combat and successfully face FCA allegations.
Today's Episode: What Will Hospices Face and What Can They Do About It
In this first episode of the Husch Blackwell Hospice Team’s 3-part “Hospice and the False Claims Act” series, Husch Blackwell’s Meg Pekarske, Bryan Nowicki, Jody Rudman and Brian Flood discuss how the False Claims Act (FCA) has historically affected hospices and the emerging areas of potential FCA exposure for hospices. These include two hospice FCA cases being considered by the U.S. Supreme Court relating to physician certifications of terminal illness and the FCA implications relating to the receipt and use of COVID-19 relief funds. The Hospice Team provides their insights and tips about how to proactively approach FCA allegations.
In this inaugural episode of our Hospice Audit Series, Husch Blackwell’s Meg Pekarske and Bryan Nowicki review three recent audit examples that resulted in multimillion-dollar extrapolated overpayments being thrown out by the Centers for Medicare & Medicaid Services. Meg and Bryan saved hospice clients over $50 million in alleged overpayments in these three audits alone! The strategies and arguments discussed on this podcast can help other hospices in similar situations.
Information related to this episode:
- HomeCare: Husch Blackwell Secures Hospice Overpayment Reduction
- News release: Husch Blackwell's Hospice Team Opens 2021 with Significant Audit Victory
- Husch Blackwell's Hospice Medicare & Medicaid Audits Team
- Hospice Medicare Audits: Strategies for success
- Hospice Medicaid Audits: Vigorous advocacy
Strategic Restructuring for the Future: Exploring How Hospices Are Using Joint Ventures, Mergers and Acquisitions, and Service Diversification to Transform
Change, transformation, disruption: whatever you want to call it, it’s happening in the hospice industry over the next 5 years. It is unquestionable that the carve-in to Medicare Advantage, the rise of value-based care and steady market consolidation is changing the playing field. How do hospices respond? In this new series, we explore how hospices are and can restructure their businesses. We discuss the opportunities and limits of different models: palliative care, affiliations for payor contracting or the more transformative change brought through a merger or acquisition. While there is no one-size-fits-all approach, hospices can explore new ways of being. We are excited to guide you on this road and hope these conversations help as you explore these important questions within your organization and determine your best path into the future.
Today's Episode: The State of the Hospice Market
Join Husch Blackwell's Meg Pekarske as she talks with Mark Kulik, Managing Director at the Braff Group, who shares his insights on growth and change in the hospice industry and the forces at work. They explore who the “disruptors” are, who is leaving the market and what matters to those who continue onward. Drawing parallels to change in other healthcare sectors, Mark opines on what the hospice market may look like in 5 and 10 years. We hope you enjoy the conversation and it leaves you with a new insight or perspective on where hospice is going.
The “rules of the road” for Provider Relief Funds continue to evolve. Recent actions by Congress and the U.S. Department of Health and Human Services provide further clarification in key areas that are helpful to hospices. In this episode, Husch Blackwell’s Meg Pekarske and Andrew Brenton analyze the latest developments and share insights on calculating lost revenue and preparing for compliance reporting when it arrives.
The latest COVID Relief and Funding law passed in December 2020 brings dramatic changes to the hospice survey process. While CMS will need to engage in future rulemaking to implement the new framework, Congress created a clear outline that includes significant financial remedies and makes all survey results publicly available. In this episode, Husch Blackwell's Meg Pekarske breaks down key components of the legislation with Hospice & Palliative Care team members Bryan Nowicki, Emily Park and Liz LaFoe. The team offers practical insights on how hospices can change their approach to survey defense in this altered landscape. Hope you enjoy the conversation!
In this episode, Husch Blackwell's Meg Pekarske is joined by colleagues Jenna Brofsky, Erica Ash and Wakaba Tessier who provide an update on the legal landscape related to COVID-19 testing and vaccinations. Their conversation explores the liability protections provided by the PREP Act and the legal considerations hospices need to account for when establishing a vaccination program. They break down the latest EEOC vaccination guidance and what it means for hospices as employers, and offer practical insights for navigating the challenges presented by mandating or otherwise encouraging employee vaccinations.
While nothing is easy these days, we are hopeful this discussion will leave you with some clarity that can ease the burden as you juggle the challenges of the day.
In today’s conversation Husch Blackwell's Meg Pekarske sits down with William Finn, the CEO of Hospice of the Western Reserve, where they share stories of change, innovation and opportunity in hospice and palliative care. Bill, Meg likes to say, is a man who is always “up to something.” He sees change on the horizon and leans into the opportunities it provides. During his tenure at Hospice of the Western Reserve, he has expanded the depth and breadth of the organization through new partnerships, the development of new technologies and better ways to deliver patient care. Bill’s insights into where end-of-life care is going and the roadmap we need to get there will leave you ready to “go get up to something” yourself. Thanks for listening and enjoy the conversation.
Join Husch Blackwell's Meg Pekarske as she further explores good governance in hospice. In this conversation, Meg is joined by fellow attorney Stephanie E. Kaiser as they delve into the details about how a “good” board functions, what are the common attributes and how you can measure performance. They discuss the role of sub-committees and term limits, what makes a good board agenda and minutes, and the essential elements of effective board infrastructure. If you like this episode, the next session in this series will discuss common board problems and tips for dealing with them. Stay tuned for the release of that episode in 2021.
With all that 2020 has brought, the Information Blocking Rule that came out of the Cures Act was under the radar of many hospices. Thankfully, HHS extended the compliance date for the Rule to April 5, 2021, from November 2, 2020. With this additional time, hospices need to evaluate how they will achieve compliance; what policies they need to update; the work they need to do with their EMR vendor; and their rollout to patients, families and staff. In this conversation, Husch Blackwell's Meg Pekarske is joined by colleagues Wakaba Tessier, Tracey Toll and Kelsey Anderson to gain their insights on these questions and more.
The AseraCare court decision benefited hospices and physicians, particularly by recognizing the uncertainty surrounding prognostication of a six-month life expectancy and the principle that two physicians can disagree about prognostication and neither be wrong. The decision’s future, however, is uncertain, as the U.S. Supreme Court may weigh in. In this episode, Meg Pekarske is joined by Bryan Nowicki, Joe Diedrich and Jody Rudman to discuss their work in representing national hospice, physician and healthcare organizations in advocating to the Supreme Court that it should review and reverse a lower court decision—the Care Alternatives case—that rejected the AseraCare holding.
As we approach the 40th anniversary of the Medicare hospice benefit, we stand at an important reflection point to evaluate end-of-life care and map its future. In this new series, we gather leaders and thinkers from a range of disciplines to explore our needs at the end of life, how they have changed over time and how care models need to adapt. We will consider our societal relationship to mortality and what impact the growth of Hospice & Palliative Care has had on how we meet the challenges of death and loss. Our guests will share their perspectives on the policy, legislative and healthcare delivery changes needed to enhance how we care for those with life-limiting conditions and ensure wellness at all stages of life. We hope you enjoy these insightful conversations and that they inspire positive change in how we care for one another at the end of life.
Join Meg Pekarske in this deep and meaningful conversation with Dr. Janet Bull as we explore how best to relieve suffering at the end of life and her reflections on what death has to teach us about living. Janet’s perspective is profoundly unique and is informed by being a witness to both the beginning of life – as an obstetrician-gynecologist – and toward the end of life as a hospice physician and Chief Medical Officer of Four Seasons, a nationally recognized leader in caring for those with serious illness. Janet has devoted the second half of her medical career to end-of-life care. She is a long-time leader in Hospice & Palliative Care, serving as past President of the American Academy of Hospice and Palliative Medicine and conducting significant research on the role and impact of palliative care in our healthcare system. In this episode, Janet shares what her life’s work has taught her on how we care for the dying, how it has evolved over time and what remain our greatest hurdles to ensuring good deaths. We explore what influence the growth and acceptance of hospice care has had on our societal relationship to mortality and where we have yet to go to ensure quality end-of-life care. We hope you enjoy this expansive conversation and that it enriches your thinking about how we can better serve those experiencing death and loss.
The Trump Administration has shown an interest in regulatory reform with the goal of reducing the burden on regulated parties such as hospices. This has recently come to the forefront as part of the administration’s efforts to lessen the impact of the coronavirus on the economy. In this episode, Husch Blackwell's Meg Pekarske hosts a lively conversation with colleagues Bryan Nowicki, Emily Park and Liz LaFoe about several recent reform efforts and how they may impact future enforcement related to hospice audits, investigations and surveys.
September was another busy month as hospices and other providers try to keep pace with the government’s constantly evolving rules and standards around various COVID-19 federal relief programs. In this episode, Meg Pekarske, Tom O’Day and Andrew Brenton hone in on recent key changes to the Families First Coronavirus Response Act (FFCRA) paid leave requirements and Provider Relief Fund compliance reporting requirements, and discuss what these changes may mean for hospices.
In this episode, Husch Blackwell's Meg Pekarske is joined by colleague Stephanie Kaiser for a rich conversation on what it means for a hospice board to carry out its fiduciary duties and how this relates to the role and responsibilities of hospice executives. Through counseling and training boards across the country, Stephanie has gained unique insights on the inner workings of boards, and breaks down what good governance looks like in action. Stephanie debunks common misconceptions on what defines a “good” board and provides practical tips on how hospice executives can and should engage and inform their boards. We also discuss when boards and individual members are liable and how to guard against such claims.
No employer wants a union. While unions have not had deep presence in hospice, hospice employers are not immune to unionization efforts.
In this session, Meg Pekarske is joined by her colleagues Jon Anderson and Tom O’Day, who offer their insights on what makes unions attractive to employees and what you can do about it. The session addresses how a well-trained management staff can identify union activity at the outset and can use proven human resource best practices to effectively prevent a union effort and, if one arises, to help your employees make good choices. The time to prepare for a union campaign comes well before the union knocks at the door. What you do now will improve your chances in this high-stakes game.
In this episode of Husch Blackwell's Hospice Insights podcast, Meg Pekarske and Andrew Brenton review the new rule’s key takeaways and flexibilities, and discuss navigating compliance.
Additional resources:
- FY 2021 Hospice Wage Index Final Rule
- FY 2021 Hospice Wage Index Rule: What We Wanted vs. What We Got
- CMS Model Election Statement Example
- CMS Model Election Addendum Example
- Medicare Hospice Regulatory Conditions of Payment
COVID-19 has affected all aspects of hospice care, operations and personnel, including the person whose judgment is at the center of the Medicare hospice benefit: the hospice physician. From new regulations addressing telehealth and virtual visits to the practical changes brought on by the pandemic, hospice physicians have had to adapt to ensure continuation of services that are compliant with evolving CMS requirements. In this episode, Meg Pekarske and Bryan Nowicki discuss the increased significance of, and scrutiny applied to, hospice physicians in the age of COVID-19, and identify potential traps and opportunities.
COVID-19 threw a wrench into certain hospice audit activity, but the machine rumbles on. In today’s episode, Meg Pekarske, Erin Burns and Bryan Nowicki discuss the current state of hospice audits, including TPE, UPIC, and OIG audits and the high number of technical denials hospices have seen lately. The team highlights the top five most frequently seen technical denials in 2020 and provides first-hand insight into CMS’s QIC Telephone Discussion Demonstration.
In this episode, Meg Pekarske has a conversation with Carla Davis, CEO of Heart of Hospice, where they discuss Carla’s path to hospice and her vision for the future of end-of-life care. They explore the question of what leadership looks like in “good” and “bad” times and what remains constant in times of change. Carla shares her insights on how being open to the unplanned and unbudgeted opportunities that cross our paths can be defining moments for organizations. Carla is an engaging leader who has her finger on the pulse of where we are and where we are going. We hope you enjoy the conversation.
The 2019 Aseracare Court of Appeals decision was lauded by hospices as appropriate push-back to overly aggressive whistleblowers and government enforcers. Its central holding, that two physicians can reasonably disagree about a patient’s six-month prognosis and neither one be wrong, made it more difficult for hospices to be held liable for their physicians’ good faith exercise of clinical judgment. Two subsequent court decisions, however, threaten to roll-back the Aseracare holding and reintroduce uncertainty and increased risk for hospices. In this episode, Meg Pekarske and Bryan Nowicki discuss these cases, their implications and the ongoing advocacy efforts in this area of law.
For resources related to this episode, please see the following:
- Aseracare and Care Alternatives
Last year, confusion and consternation ensued when CMS finalized new requirements for the hospice election statement and an “addendum” with patient-specific information about the hospice’s coverage responsibility. Those requirements are set to become effective as early as October 1, 2020. In this episode, Hospice & Palliative Care attorneys Meg Pekarske, Bryan Nowicki and Andrew Brenton break down these requirements and discuss their implications for hospices. Among other things, the attorneys address the controversial position CMS has taken in characterizing the addendum as a condition of payment for hospice care.
For resources related to this episode, please see the following:
- CMS, FY 2021 Hospice Wage Index Proposed Rule
- CMS, Proposed Modifications to Model Election Statement and New Model Addendum
- CMS, FY 2020 Hospice Wage Index Final Rule
Overview:
This episodecommonly asked questions from hospices across the country. The group shares legal and accounting perspectives as well as practical considerations to help hospices as they operationalize their use of relief payments.
Presenters:
Husch Blackwell’s Hospice & Palliative Care attorneys Meg Pekarske, Bryan Nowicki and Andrew Brenton, and Crowe’s accounting professionals Bucky High, Dan Yunker and Stephanie Cerney/professionals/meg-pekarske
Resources:
- Presentation Slides: COVID-19 Town Hall for Hospices
- CARES Act Provider Relief Fund Webpage
- HHS Provider Relief Fund Frequently Asked Questions (May 18, 2020)
- Husch Blackwell: Risks of Spending Public Health and Social Services Emergency Fund Payments
- Husch Blackwell Coronavirus Toolkit
- Husch Blackwell CARES Act Updates
The only thing constant is change…since our last podcast, evolving guidance from HHS continues to create confusion regarding how the relief payments were calculated and under what circumstances providers should accept or return relief payments. In this episode, Hospice & Palliative Care attorneys Meg Pekarske, Bryan Nowicki, and Andrew Brenton break down the latest Relief Fund guidance from HHS and discuss its implications for hospices.
In this episode, Meg Pekarske talks with Michael McHale who is President and CEO of TRU Community Care. Michael is a friend, colleague and hospice innovator. As a former board member of the National Hospice and Palliative Care Organization (“NHPCO”), Michael is always thinking of ways to lead proactive growth and change. He is driven to solutions by the fundamental question: “how can we better serve the needs of our community?” In today’s conversation, Michael shares his insights on where hospice care is going, how we transform as an industry and the challenges to change. We explore how a new delivery system TRU is developing will radically change how they care for patients across the organization’s continuum of service, which spans PACE, Serious Illness, Home Health, Palliative Care and Hospice. Michael shows how financial investments in new ways of doing things can pay for themselves through economies of scale and staffing efficiencies. While the complexities of care delivery and payment can be dizzying, it is clear from this lively conversation that being grounded in the seminal question “how can we help” is the way forward for us all.
On Friday, April 10, the U.S. Department of Health and Human Services began disbursing $30 billion in relief funds directly to Medicare providers, including hospices. The use of those funds, however, is subject to a number of terms and conditions that raise significant questions. Failure to adhere to those terms and conditions could require a hospice to return those funds or result in liability during future audits or enforcement actions. In this episode, Hospice & Palliative Care attorneys Meg Pekarske and Bryan Nowicki analyze those term and conditions, and provide a framework for how hospices should begin reviewing these requirements in order to establish systems for compliance that mitigate risk.
In today’s COVID-19 edition of the Hospice Labor and Employment Trends series, Meg Pekarske talks with colleague Tom O’Day about the Families First Coronavirus Response Act (FFCRA). As one of Husch Blackwell’s healthcare-focused employment attorneys, Tom is uniquely situated to interpret the FFCRA for healthcare providers of all kinds, including hospices.
Change is fast-paced in the world of COVID-19. On Monday, March 30th, CMS released an interim final rule along with hospice specific waivers. Your Hospice Team discusses these recent developments and their impact on telehealth, face-to-face encounters, virtual visits and Medicare appeals and audits.
In today’s episode, your Hospice Team shares insights on operationalizing recent government guidance for hospices facing coronavirus obstacles. We discuss the role of virtual visits, how to use telehealth, and the practical impact of the Medicare appeal waiver.
These are extraordinary times. COVID-19, or the novel coronavirus, has disrupted the life of every American and every business. Hospices are no exception. In fact, they are on the frontlines, responsible for providing care to the elderly, a population extremely susceptible to COVID-19. The Husch Blackwell Hospice Team is fundamentally a group of problem solvers, who are here with and for you during these trying times, to provide support, guidance, ideas and strategies in the face of this unprecedented issue.
In this episode, the hospice team discuss the latest round of audits from the Office of Inspector General (OIG) which focus on Durable Medical Equipment (DME), supplies and their “relatedness” to a patient’s terminal prognosis. Whether or not you are subject to these Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) audits, we share strategies for withstanding government scrutiny of your relatedness determinations, including the who, when, why and how of your decision making. Check out the Hospice Resource Library for tips and tools related to this episode.
In this episode, we share a lively discussion with colleague Jon Anderson on what should be front of mind for hospices in 2020 from a labor and employment perspective. Jon shares insights on what the new developments in wage and hour and employment discrimination laws mean for hospices across the country. We also delve into the important intersection between human resources and health care compliance when it comes to investigating compliance concerns and conducting exit interviews. Stay tuned for future podcasts in our Hospice Labor and Employment Trends series.
In this episode, the hospice team shares insights on how to manage and succeed in responding to additional documentation requests (“ADR”) stemming from Targeted Probe and Educate (“TPEs”) projects. We discuss the unique features of TPE and winning strategies for responding. Check out the Hospice Resource Library for tips and tools related to this episode.
In this episode, your hospice team discusses the exciting opportunities resulting from their move to a new law firm: Husch Blackwell. Their new home enhances their ability to provide wide-ranging and value-added counsel and problem-solving to hospices facing audits, surveys, enforcement activity, litigation, and regulatory concerns. It also augments their hospice expertise in areas like Medicare Advantage, joint ventures, mergers and affiliations, ACO contracting, and alternative payment models. The team is excited to grow with their clients and make a positive contribution to the hospice community.