MEDICARE HOSPICE CARE FOR BENEFICIARIES IN NURSING FACILITIES: COMPLIANCE WITH MEDICARE COVERAGE REQUIREMENTS

This report determines the extent to which hospice claims for beneficiaries in nursing facilities in 2006 met Medicare coverage requirements.

Eighty-one percent of claims did not meet at least one Medicare coverage requirement pertaining to election statements, plans of care, services, or certifications of terminal illness. An additional 1 percent of claims were undocumented. Medicare paid approximately $1.8 billion for these claims.
Claims from not-for-profit hospices were less likely to meet Medicare coverage requirements than those from for-profit hospices. Specifically, 89 percent of claims from not-for-profit hospices did not meet Medicare requirements, compared to 74 percent of claims from for-profit hospices.

Read More