The Expertise You Need for Your Hospice and Home Health to Advance!










Last Update to this page 7/2/2021. Most current news on top. Scroll down for past reports.

7/2/2021: Despite it's being the Home Health 2022 Proposed Rule, important aspects regarding Medicare-reimbursed hospice is included! See the rule here!  And scroll down in this CMS talking-points document  to more easily see what directly applies to hospices!

4/9/2021Find the FY 2022 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements here. The proposed rule will be available until the regulation is published on 4/14/2021, and public comments can be posted until 6/7/2021.

3/4/2021: Effective in February, 2021, find the updated HIS Manual Version 3.00, here!

1/27/2021: As of January 1, 2021, CMS is seeking to identify what effects the inclusion of the traditional Part A Hospice Benefit, as well as the traditionally-included parts that otherwise would have been Medicare Part B costs, in Medicare Advantage (MA) plans might be. See the CMS notification, to learn more: “The CY 2021 Hospice Benefit Component is part of the larger VBID Model [Value-Based Insurance Design Model], which has 19 Medicare Advantage organizations (MAOs), providing care to 1.6 million Medicare patients in 45 states, the District of Columbia, and Puerto Rico.” 

8/1/2020: Important! Have you updated your Election Statement yet? Effective on 10/1/2020, you must include new terminology and the ability to provide a timely addendum upon patient/representative request! CMS has provided TEMPLATES for you to use: CMS's Model Election Statement Template, and CMS' Model Election Statement Addendum Template! and, to find the source of these, your new responsibilities, you need to look into the FY2021 Hospice Wage Index and Payment Update, effective on 10/1/2020. Yes, it's in there (toward the bottom of the document).

7/20/2020: In case your Policies and Procedures don't include all that's required now to protect the rights of ALL people, especially during this COVID-19 Public Health Emergency, see this Office of Civil Rights Guidance on Protections Protecting Race, Color, National Origin Demonstration During COVID-19

7/7/2020: Be sure you know, and act! Effective on 6/30/2020, the temporary exemptions for Hospice Quality Reporting Requirements ended! Read CMS' COVID-19 Public Health Emergency Tip Sheet now to know what you need to do. There's no time to waste!

5/29/2020: Critical impacts coming for hospices if H.R. 5821 - the “HOSPICE Act” (aka “Helping Our Senior Population in Comfort Environments Act”) - is passed!

As if hospice providers across the country aren’t already facing myriad challenges and obstacles, critical changes included in the HOSPICE Act (H.R. 5821) could derail or at least deplete hard earned finances, community confidence, and operational success.

The HOSPICE Act was introduced and moved to the House of Representatives in February 2020, and will eventually continue toward its potential approval and implementation before you know it.

What this Act means for hospice companies? If passed as is, every Medicare-certified hospice could face:

·      Increased frequency of recertification surveys from every 3 years to every 2 years.

·    Intensified scrutiny by surveyors, subsequent to “… the comprehensive training of State and Federal surveyors …” intended to arm surveyors with “… survey and certification techniques…” heretofore not so required by CMS.

·    A “Special Focus Program” by which any hospice found to have “… failed to meet applicable requirements …” would face subsequent surveys “… not less frequently than once every 6 months.”

·    Fines: civil monetary penalties “… not to exceed $10,000 for each day of noncompliance …”, imposed for those days during which the hospice is deemed to be noncompliant.

·    “Suspension of all or part of the payments to which a hospice program would otherwise be entitled …” when deficiencies have been found within the hospice.

·    Survey results published for public viewing.

If you are concerned about how your hospice would fare, if and when these requirements are imposed, consider contacting me. I can help you remotely (or eventually in person) to identify your risk and potential remedies as needed. Your hospice success is my passion.


Click HERE for the CMS Hospice Item Set (HIS) Submission Requirements Webinar, presented on 3/3/2020.

What you need to know about the HOSPICE (Helping our Senior Population in Comfort Environments) Act, H.R. 5821!  In response to the findings reported in 2019 by the OIG (see July, August and November reports below), the HOSPICE Act is on its way to the House of Representatives for consideration. Included in this Act are increased requirements to be met by hospices in order to improve integrity, possible monetary penalties for failing to do so, and increased frequency and scrutiny of certification and accreditation surveys.

C'mon now, hospice companies! Make sure your RNs are supervising your Aide care and care plans every 14 days or more! See this November 2019 OIG Report Chastizing hospices AGAIN! We can do better than this! Contact me to learn how to schedule and PROPERLY supervise your Hospice Aide Services.    

Get a clearcut picture of what the current HIS measures are, and how they impact your quality ratings (and therefore your Hospice Compare scores!) HERE!

If you didn't think your Hospice Compare scores will affect your referrals, think again! Effective 11/29/2019, hospitals will be required to provide prospective hospice patients with your Hospice Compare information at hospital discharge time!! See the new hospital rule HERE!

Insightful wisdom found in this article today: Modernizing the Medicare Hospice Benefit!

Is your hospice guilty? See This August 2019 OIG REPORT indicating that "Medicare Part D Is Still Paying Millions for Drugs Already Paid for Under the Part A Hospice Benefit"!  

Click here to see the MLN Update to the FY 2020 Hospice Payment Rates, Cap, Wage Index & Pricer.

 In this August 7, 2019 Hospice News article, Jim Parker reported:  Leaders in the influential Ways and Means Committee in the U.S. House of Representatives have called for stronger supervision of hospice regulatory programs in a letter to Seema Verma, administrator of the U.S. Centers for Medicare & Medicaid Services (CMS).

“Committee Chairman Richard Neal (D-Mass.) and Ranking Member Kevin Brady (R-Tex.) signed the letter requesting more details from CMS about the agency’s oversight of hospice providers in the wake of two July reports from the U.S. Department of Health & Human Services Office of the Inspector General (OIG) that cited deficiencies in regulatory compliance, including some that represented serious safety issues.”

Mr. Parker noted that “…the House Ways & Means Committee is one of the most powerful in Congress, having jurisdiction over taxation, tariffs, Medicare, Social Security, child support laws and numerous other programs….”

“With regulatory scrutiny on the rise, some hospice providers are concerned that increased audits associated with utilization of more expensive care could be an unintended consequence.” Quoted from: this Hospice News article "CMS Final Rule Could Lead to More Hospice Audits"! And ...

... Quoting Jim Parker, from his Hospice News article dated July 30, 2019, “Hospices are under increasing levels of regulatory scrutiny from the U.S. Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health & Human Services Inspector General’s Office (OIG), particularly in the form of audits, and many hospice leaders are expressing frustration with the associated costs and workload.”

So, how is your hospice preparing for the OIG’s recommendations to CMS:

1.      To force stronger survey processes?

2.      To tie hospice payments more directly to quality of care?

3.      To make more of your hospice’s information public?

How are you protecting your hospice’s integrity? How are you assuring and proving that your hospice billing is appropriate and legitimate?

Here's where you will find the alarming OIG reports, for which your hospice must prepare!


From a 6/13/2019  Hospice News Article, helpful important information about opioid disposal laws and background. ** BE SURE to follow YOUR State's Rules!**   


How are you doing your self audits to prepare for CMS Surveys?? Read why, here!  and then, contact me to help you prepare!


Are you missing out on SIA reimbursements?? CMS has provided them in order to reward your hospice for attending to your patients' needs in the final days of life.  Click HERE to find out more about the SIA!! and how it's not being used to the fullest!


See the CMS HQRP announcement dated 4/1/2019 here! You'll find the information you need regarding the newest plan for “Public Reporting of the Hospice Visits when Death is Imminent Measure Pair".


It's time to self report your 2018 Hospice CAP! Click  HERE to read NGS' portal instructions -- DUE by 2/28/2019 to avoid payment penalties!


You can use This Hospice PRICER Quick Reference Tool to estimate your individual hospice claim reimbursements!!


Here is the link to the new version of the Hospice Item Set (HIS) Manual!


Hospices are facing critical scrutiny, as detailed in this Home Health Care News article dated 10/23/2018: Click here to learn about the risks you face! . To avoid these worst-case compliance errors, contact me to get the expert assistance that you need!


8/9/2018: Published! FY2019 Hospice Wage Index Final Rule 


8/1/2018: OIG report just out includes alarming statistics that could affect the future of Medicare hospice care. Beware, hospice companies-- are you serving your patients well on weekends? See the OIG's opinion (pages 14-15)! Read about it and more HERE!


Hospice Must Read! Important Billing and Claims Processing Information. Find what you need to know Here!


BREAKING NEWS! Mary Ann Dekker of ADVANCING YOUR HOSPICE AND HOME HEALTH LLC will be presenting, live and in person, at the Michigan Home Care and Hospice Association (MHHA) Annual Conference THIS WEEK! Mary Ann, who has been working to help hospice and home health companies across the United States to succeed, will explore "Achieving Quality Despite Maintaining Compliance: Resolving the Conundrum" on Wednesday morning, April 25, 2018, at the Amway Grand Hotel in downtown Grand Rapids, Michigan!  Additionally: Beginning in December 2017, the Accreditation Commission for Health Care (ACHC) has put Mary Ann's experience and wisdom to work as an ACHC Hospice Surveyor. Keep Mary Ann in mind to find out how you can prepare your hospice or home health for Medicare survey, whether ACHC, CHAP, Joint Commission, or even if you are seeking certification without accreditation!

Do you know how to make sure your data is easily and correctly accessible in Hospice Compare? Click HERE for CMS' new guidance on how to update your demographic data.

Be sure to view your Hospice CAHPS results from Quarter 2, 2015 to Quarter 1, 2017:   CMS Instructions: How to Access your Hospice CAHPS Provider Preview Report .  It’s important to note:

·        If you find a Hospice CAHPS error in your Preview Report, email your request for review to BEFORE 11:59:59 p.m. PST on December 30th!

·        Since the data in your Preview Report is case-mix adjusted, it may look different from the data you receive from your vendor, meaning not that there’s an error, but that it is simply displayed differently.

·        You can download and save your Provider Preview Report to keep for future reference, since they won’t be available in CASPER after 60 days from the date they were posted December 1st.

Your Hospice Item Set (HIS) results from Quarter 2- 2016 to Quarter 1-2017 are also now available in a separate report within CASPER.  Just like the CAHPS Report, if you find errors, you have until December 30th to email your request to (**NOTE: This is a different email address from the one above!**)

Hospice Compare news:  Here is CMS' third quarter Hospice Quality Reporting Program (HQRP) update. And, to assist you: CMS has provided this  "Updated Guidance on How to Update Demographic Data within ASPEN"                  

Hospice providers: you only have until 11/15/2017 to correct your HIS data for patient discharges for 2Q2016 through 1Q2017. After that “Freeze Date”, even though you can submit corrections to any errors you find in your CASPER Preview Report between 12/1/2017-12/30/2017, they will show up on your Hospice Compare report, scheduled to be publicized in February of 2018.  Click Here  to review these details from CMS!

Your hospice’s opportunity to test CMS’ “…draft HEART Pilot instrument…” is here!  HEART is the proposed Hospice Assessment and Evaluation Reporting Tool, which is being developed in order to allow “…a broader picture of the quality of care provided by hospice agencies, as well as a more comprehensive understanding of patient needs and service delivery for hospice patients…” It is anticipated to become a next step in the HQRP.  By participating in this Pilot Program, CMS promises to give your hospice special training, help and support.  If I were you, I would consider getting on board now: the DEADLINE for SUBMITTING YOUR INTEREST FORM IS October 31st!!   Click Here for the CMS HEART Pilot Program Details!      Click HERE to complete your Interest Form By October 31, 2017.  

Did your hospice successfully meet all the HQRP reporting requirements? Click Here to hunt for your hospice's name!

Have you ever wondered about providing services to someone imprisoned? Here is a link to see what Medicare can and cannot do for someone imprisoned.

CMS has put together three new resources that can help you:

Effective next week (October 1, 2017) CMS is expanding Targeted Probe and Educate (TPE). Will you win Round 1? See the TPE Flow Chart

Hospices & Home Health Providers under NGS Jurisdiction 6: Here is the LINK to: "The Reason Code Look Up Tool for the Top Claim Errors...”

Your "Hospice Provider Preview Reports" for quality measure results during 1Q2016 through 4Q2016 can now be viewed before September 28, 2017 , to assure you notify CMS of any errors in time for the next "Hospice Compare Refresh"!  Here are the Instructions to Access Your Report!

See this link This Link  for good information & Edo Banach's suggestions regarding opioid disposal-- state laws vs federal--  he says:  "NHPCO supports a national policy and uniform set of practices..." and has started work on federal legislation.

Are you moving forward with your policies and procedures, trainings, and table-top and full-scale exercises?  Here are the Interpretive Guidelines for the Emergency Preparedness CoP!  Will you be ready to demonstrate compliance starting this November?


CMS has released Hospice Compare for public viewing!  Click here  to see how your hospice appears and how it compares! 

CMS Rescinds Proposal Requiring Accrediting Organizations to Publicize Survey Reports & Plans of Correction.pdf

Find fascinating information about your hospice and all Medicare certified hospices across the country from CY 2015, published 8/9/2017:      Here's the Provider Comparisons Table   and      Here's the State-by-State Comparison Table   Note that, per   the CMS source, "The information presented ... does not indicate the quality of care provided by individual hospice providers. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in patient populations."

Here is the Final Rule FY 2018 Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting Requirements, published in the Federal Register on August 1, 2017.

Watch your mail and check within CASPER to confirm whether your hospice was sent a Non-Compliance Letter today, 7/18/2017!  CMS reports that this letter was sent to every hospice who did not comply with the HQRP requirements for calendar year 2016. Those who were non-compliant in 2016 will have a 2 percentage point reduction in their 2018 Annual Payment Update. *** NOTE that if you receive a Non-Compliance Letter but you believe you were indeed compliant, you only have until 8/17/2017 to email your reconsideration request to CMS. Information on this process and more can be found here!


Click here to read the Errata V2.01.1 for HOSPICE Data Submission Specifications Version 2.01.0 regarding the clarifying change in text for 3077.    


Did you know? You no longer have to squeeze your Medicare Survey Plan of Correction into that right-side-column on CMS Form 2567! Read about this welcome change here!


CMS has updated its "Master Guidance on Item A1400". Click Here to See this Item A1400 Updated Guidance


Your QRP (HIS) Preview Report is Ready to View! Hospices have until June 30, 2017 to preview your HIS results from 4Q2015 to 3Q2016.  Even though your results will be posted publicly "as is" this summer, you can submit any needed corrections and, if CMS agrees with you, your updated results should show in subsequent Hospice Compare publications.  As a reminder, Click Here for Instructions on How to Find your QRP Preview Report


5/31/2017 10:00 a.m. E.T. NGS UPDATE: I contacted NGS and attained:

The CORRECT MLN Special Addition Article Instructions for How to Submit Claims Adjustments for 2016 SIA and RHC Payment Corrections

From NGS on 5/31/2017: "CMS has corrected most of the system errors associated with 2016 Hospice Service Intensity Add-On and RHC Payments; however, Medicare systems cannot accurately reprocess claims for these two issues. Hospice providers are advised to submit claims adjustments as specified in..." an MLN Matters Article yet to be posted correctly as of 9:30 a.m. E.T. on 5/31/2017.   Click Here for Source Stay tuned to this site for the updated MLN Article when its availability is corrected!

From CMS on 5/25/2017: You can review the "Hospice Data Submission and Reporting Webinar Post-training Presentation (with Answers) Here!   And CMS adds: "Note: For the Hospice Compare, the HIS data will be displayed in late summer 2017 and the CAHPS data will be added for display in early winter 2018."     Click Here for Source

Here is the Published FY2018 Hospice Wage Index Proposed Rule 

NGS Notification on 5/22/2017:  "...current issue involving claims with reason code 32103 or 32104 being returned to provider (RTP) in error..."  "NGS is informing Part A providers, including home health and hospice providers, of a current issue involving claims with reason code 32103 or 32104 being returned to provider (RTP) in error...Providers will note that on these claims the NPI/Oscar number pair is not present in the Medicare NPI crosswalk file. This edit applies to the NPI number associated with the Oscar number....NGS is in the process of recycling the claims that were returned to provider (RTP) in error on 5/17/2017. There is no further action required by providers. The notice of elections (NOE) receipt date will not be affected by the reprocessing of these claims..."  See Here for NGS Details on this as of 5/22/2017  

NGS Notification on 5/17/2017:  “Claims with Reason Code 32103…” are being “…Returned to Provider in Error”. This includes hospice providers. NGS reports that the correction will be made soon. See Here for NGS Details on this Error

NGS Reported on 5/12/2017 that The RHC hospice payment is continuing to inappropriately pay at a high rate in certain situations. The Centers for Medicare & Medicaid Services (CMS) is aware of this issue and a resolution is forthcoming.”        Click Here for NGS Email Source                    

The FY2018 Hospice Wage Index Proposed Rule is available HERE to review. It is expected to be officially published on May 3, 2017.

From "CMS Post-Acute Care Quality Reporting Programs":

"A new Question and Answer (Q+A) document is now available in the "Downloads" section of the Hospice Item Set (HIS) webpage. The Q+A document reflects frequently asked HIS related questions that were received by the Quality Help Desk during the first quarter (January-March) of 2017. This document also contains quarterly updates and events from the first quarter as well what's coming up in the second quarter.

The Common Working File will be unavailable on Saturday, May 13, 2017, in order to do a “history archive”. This means your ability to identify beneficiary status will be unavailable during that day. From NGS on 4/4/2017:       Click Here for NGS Source

CMS HQRP Public Reporting is Coming!  Click Here for the April 27, 2017 CMS HQRP Public Reporting Training Document (PDF)


CMS  Presented an Emergency Preparedness Requirements Final Rule Training Call on April 27, 2017:  Click Here for the Emergency Preparedness Requirements Final Rule Training Call April 27, 2017 Document!

"... Is your facility prepared to meet the new emergency preparedness requirements by the November 15, 2017, compliance date? During this call, learn about implementation of the final rule, including an overview of the regulation and training and testing requirements. A question and answer session follows the presentation ... for facilities, providers, and suppliers affected by the final rule; state survey agencies; health care coalitions; and state emergency preparedness officials."   Click Here for the 3/24/17 CMS Memo.

From CMS: Hospices need to re-run your HIS reports for implementation dates of December 18, 2016 through February 26, 2017, due to a CMS calculation error! See details here--- on the CMS HIS Technical Information page.

If you have not already prepared your 2016 Pro-Forma for Provider Self-Determination of Aggregate Cap Limitation, Here is the NGS Medicare Link to the CMS Proforma and Instructions for Self-Determining and Reporting.  (Be sure, of course, to submit via your own MAC's instruction if your state is not under the NGS MAC jurisdiction!)  Your submission (and pay-back to Medicare if required) are due  no later than March 31, 2017.  Otherwise, your hospice "will be subject to a payment suspension"! 

Give your RNs and Providers a Wonderful New Tool to Assist with Opiod Management! 

The "CDC’s new Opioid Guideline App"!..."designed to help providers apply the recommendations of CDC’s Guideline for Prescribing Opioids for Chronic Pain into clinical practice by putting the entire guideline, tools, and resources in the palm of their hand...The application includes a Morphine Milligram Equivalent (MME) calculator*, summaries of key recommendations and a link to the full Guideline, and an interactive motivational interviewing feature to help providers practice effective communications skills and prescribe with confidence."   from this--the Full Story about the CDC Opioid Guideline App!       Here is your Link to the CDC Opioid Guideline App!

"Patients with incurable cancer have poor prognostic awareness the ...a detailed analysis of the dialogue between oncologists and patients in conversations with prognostic implications."     from the" Journal of Oncology Practice - published online before print January 17, 2017":    Link Here to read "Characterizing the Nature of Scan Results Discussions: Insights Into Why Patients Misunderstand Their Prognosis"

"Hospice Election Statements Lack Required Information or Have Other Vulnerabilities", in news from CMS, via "mlnconnects Official CMS news from the Medicare Learning Network":

"After a stratified random sample review of hospice election statements and certifications of terminal illness, the Office of the Inspector General (OIG) reports that more than one-third of hospice General Inpatient (GIP) stays lack required information or had other vulnerabilities.

"Hospices should improve their election statements and ensure that physicians meet requirements when certifying beneficiaries for hospice care."

from, where further information and a sample Hospice Election statement can be found!

"Hospice Care Quality Data":

"National averages of the quality measure scores of Medicare-certified hospices ...[are]... available ... on the Hospice Data Directory on National average data ...[is]... available for two quality of care datasets – the Hospice Item Set (HIS) and the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Hospice Survey. The HIS reflects provider performance on the seven National Quality Forum-endorsed quality measures  from July 2015 through June 2016. The CAHPS® Hospice Survey scores are calculated from survey responses that reflect care experiences of informal caregivers (i.e., family members or friends) of patients who died while in hospice care from April 2015 through March 2016.  Hospice Compare will be available in summer 2017.  For more information, visit the Hospice Quality Reporting webpage." from

"Hospice Quality Reporting Training" that was held on January 18, 2017...":

Here is the Link to the CMS HQRP Provider Training 1/18/2017, Including Polling Answers

Its focus was on: "... the Hospice Quality Reporting Program (HQRP). Included in the training ...[were]... upcoming data collection instructions and updates associated with the changes in the Hospice Item Set (HIS) which will become effective on April 1, 2017, in addition to the two new HIS-based quality measures that will be incorporated into the HQRP in 2017. The training ... also [included] a focus on the Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey and [offered] important insights into frequently asked questions regarding the HQRP....". 

"Hospice Quality Measure Reports Available

"Two new reports for hospices are available in the Certification and Survey Provider Enhanced Reporting (CASPER) application:

"These QM reports allow you to specify a reporting period and view your quality data at both the hospice level and patient-stay level. View the Getting Started with Hospice CASPER QM Reports Fact Sheet and the Requirements and Best Practices webpage for more information." from

And, in case you missed it!

The CMS Memo "Update on Part D Payment Responsibility for Drugs for Beneficiaries Enrolled in Medicare Hospice", dated November 15, 2016, indicated that:

Read The CMS Memo to All Part D Plan Sponsors and Medicare Hospice Providers 11/15/2016 .

And...  for some encouraging hospice-care findings:

See this Report published in the Journal of Clinical Oncology: Family Perspectives on Hospice Care Experiences of Patients with Cancer  (DOI: 10.1200/JCO.2016.68.9257 Journal of Clinical Oncology - published online before print December 19, 2016), which concluded:  "Hospice care is associated with better symptom relief, patient-goal attainment, and quality of EOL care. Encouraging earlier and increased hospice enrollment may improve EOL experiences for patients with cancer and their families."