The landscape of home health and hospice compliance is undergoing a significant shift in 2024. Medicare is ramping up scrutiny after a period of relaxed enforcement during the pandemic. This blog explores the key reasons why home health and hospice agencies should prioritize a proactive compliance assessment in 2024.
Increased Audit Activity Driven by OIG Directive
The Office of Inspector General (OIG) has issued a directive calling for more investigations, audits, and inspections of healthcare providers. This directive translates to heightened activity from Medicare contractors like Recovery Audit Contractors (RAC), Supplemental Medical Review Contractors (SMRC), and Unified Program Integrity Contractors (UPIC).
Focus Beyond Fraudulent Activity
While the OIG targets fraudulent practices, a significant portion of audits will address billing and documentation errors. These unintentional mistakes can still lead to denied payments, recoupment demands, and even potential penalties. Read the OIG Strategic Plan 2020-2025.
TPE Audits: A Stepping Stone to More Serious Reviews
Target, Probe, and Educate (TPE) audits may seem less intimidating, offering guidance alongside initial findings. However, failing to meet TPE compliance thresholds can escalate to further reviews and potentially 100% pre-payment review, placing a significant burden on agencies. If your agency has not received a TPE, you can expect one in the future.
Staffing Shortages and Compliance Risks
The ongoing labor shortage poses an additional challenge. New staff may lack the necessary regulatory knowledge, increasing the risk of documentation or eligibility errors or triggering complaints. This can escalate to investigations and threaten an agency's reputation.
Compliance as an Investment, Not Just a Cost
Investing in a comprehensive compliance assessment can be a strategic move. An annual external audit can be a strong component of your compliance program, allowing your agency or organization to uncover potential risk areas before they become a larger issue. A strong compliance track record is attractive to investors and facilitates partnerships or acquisitions.
How SimiTree Can Help
SimiTree's team of experienced compliance experts offers a full assessment to identify vulnerabilities in billing practices and clinical documentation. We mirror the approach of governmental auditors, ensuring your agency is prepared for any scrutiny.
Benefits of a Proactive Approach:
- Minimize Audit Risk: Identify and address vulnerabilities before they trigger audits.
- Reduce Costs: Avoid penalties and recoupment demands associated with non-compliance.
- Streamline Workflows: Implement best practices to optimize billing and documentation processes.
- Enhance Staff Training: Equip your team with the knowledge to ensure consistent compliance.
- Improve Patient Care: Strengthen the foundation for high-quality, compliant patient care.
Don't Wait Until an Audit Arrives
Schedule a comprehensive compliance assessment with SimiTree today. By taking a proactive approach, you can ensure your home health or hospice agency operates with confidence and minimizes disruption in the ever-evolving regulatory environment.