CMS Relaunches Hospice TPE Audits with Long-Stay General Inpatient Reviews

Morgan Lewis - Health Law Scan
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Morgan Lewis - Health Law Scan

The Centers for Medicare and Medicaid Services (CMS) announced that it had restarted the Targeted Probe and Educate (TPE) audit process, effective September 1, 2021. More recently, the Medicare Administrative Contractors for hospice have targeted “claims with revenue code 0656 [General Inpatient Care] greater than or equal to 7 days submitted with dates of service on or after January 1, 2020” for active, pre-pay medical review.

Longer general inpatient (GIP) stays have been the subject of evaluations and investigations by the HHS Office of Inspector General, which has suggested that hospices create additional controls and audit focus on hospice patients who receive GIP care for five consecutive days or more. These renewed TPE audits may target hospices with hospice inpatient units, as those hospices have historically had longer GIP stays. Targeted hospices will undoubtedly feel the burden of additional audit activity, especially when care remains in a fragile state during the COVID-19 pandemic with an ongoing nursing shortage in many areas.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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