Navigating Home Health and Hospice Compliance: A Comprehensive FAQ Guide

In the rapidly evolving landscape of home health and hospice, staying informed about compliance and regulatory changes is crucial. SimiTree's recent webinar, featuring experts Debra Grott, RN, COS-C, Director of Compliance & Regulatory, and Laurie Newlun, MSN, RN, CHC, CHPC, Senior Manager of Compliance & Regulatory, delved into the latest trends and provided insights into navigating the complex world of compliance. This blog post compiles key FAQs from the webinar, offering a comprehensive guide for professionals in the home health and hospice industry. If you have any further questions about compliance beyond what our FAQ covers, please don't hesitate to contact us in any way that's most convenient for you. Useful links and more information on contact options can be found at the end of this blog post. 

FAQs and Answers from Compliance in 2024: Essential Trends, Rules, and Insights for Home Health & Hospice Providers 


  • Targeted Diagnoses in TPE Audits: 
    • Question: Can you provide the 11 diagnoses that are targeted? 
    • Answer: TPE audits typically focus on 30-day claims with 2-6 visits and 10 specific diagnoses. The usual 10 diagnoses include I11.0, G20, Z46.6, I25.10, J44.1, N39.0, I10, J18.9, J44.9, and I87.2. However, it's crucial to refer to the TPE letter to confirm the targeted diagnoses. 
  • Error Tolerance Rate Calculation: 
    • Question: Is the error tolerance rate based on the number of claims or the total amount of claims? 
    • Answer: The error tolerance rate is typically based on the total dollar amount of the claims paid, according to our experience. 
  • Face-to-Face Encounter Guidelines: 
    • Question: Can we use a specialist's encounter note for HH F2F-referral if the PCP refers for the reason the specialist is seeing the patient? 
    • Answer: Unfortunately, CMS guidelines for Face-to-Face encounters are clear. The encounter must be performed by the certifying physician, a physician who cared for the patient in the acute or post-acute care facility, or an allowed non-physician practitioner. 
  • PEPPER Reports Accessibility: 
  • GIP Level of Care in Hospice: 
    • Question: Can we discharge a patient needing GIP level of care, transfer them to the hospital, and readmit them when they come home? 
    • Answer: COP requirements mandate that hospices must provide all four levels of care, including GIP. Discharging and readmitting for this purpose may not align with compliance. 
  • Corporate Compliance Program Requirements: 
    • Question: Does an active QAPI program meet the requirements for a corporate compliance program? 
    • Answer: While a QAPI program is a COP requirement, a corporate compliance program has seven elements outlined by the OIG. Quality assurance and performance improvement are part of it but not the complete program. Learn the four elements of QAPI 

Staying abreast of compliance and regulatory changes is essential for home health and hospice professionals. This comprehensive FAQ guide serves as a valuable resource, addressing common queries and providing insights from experts in the field. Stay compliant, stay informed, and ensure your organization thrives in the dynamic landscape of home health and hospice. Continue reading for useful webinar links and to learn more about our services. 


Watch the Webinar: Compliance in 2024: Trends, Rules, and Insights for Home Health and Hospice 

For those eager to delve deeper into the insights shared during the webinar, the recording is available for viewing on SimiTree's YouTube channel. Alternatively, you can find it on our Webinars page for easy access. 


About the Webinar 

Join SimiTree compliance and regulatory experts, Debra Grott, RN, COS-C, Director, and Laurie Newlun, MSN, RN, CHC, CHPC, Senior Manager, to stay up-to-date on the latest trends shaping the home health and hospice industry, provide a breakdown of new rules in hospice, and offer specific insights into regulatory changes. 


Webinar Highlights:

  • Trends in Compliance: Explore the evolving landscape of compliance in home health and hospice, and understand how these trends impact your organization.
  • New Rules in Hospice: Get expert insights into recent regulatory changes in hospice care, ensuring you stay ahead of the curve in providing quality services.
  • Insights from Intermediaries: Learn from industry intermediaries as they share valuable insights and practical advice to navigate the compliance maze effectively.
  • Top Denial Rates: Gain a deeper understanding of the common reasons for denials and strategies to mitigate them, enhancing your organization's financial health.
  • Emerging Auditing Trends: Stay informed about the latest auditing trends that may impact your operations and learn proactive measures to address potential challenges.
  • Updates from MACs: Get the most recent updates directly from Medicare Administrative Contractors, ensuring your organization aligns with the latest regulations and requirements. 
    This webinar is a must-watch for home health and hospice professionals, administrators, and compliance officers seeking to enhance their understanding of the industry's dynamic landscape.  



How SimiTree Can Help 

SimiTree is your trusted partner in navigating the complex landscape of compliance, regulatory, and quality goals. Our certified and experienced experts offer a range of services to address your organization's unique needs: 

  • Full Compliance Assessments: Comprehensive evaluations to ensure your organization meets the latest compliance demands. 
  • HIPAA Privacy Risk Analysis: Thorough analyses to safeguard patient privacy and adhere to HIPAA regulations. 
  • Pre-Bill Audits: Proactive audits to identify and rectify potential issues before billing. Learn all about SimiTree’s pre-bill audit solutions.  
  • Corrective Action Plan Development and Implementation: Tailored plans to address compliance gaps and enhance operational processes. 
  • ADRs, Denials, and Appeals: Assistance in managing audits, denials, and appeals for a streamlined reimbursement process. Learn more about ADRs, Denials, and Appeals services at SimiTree. 
  • Survey Readiness and Mock Surveys: Preparation to navigate surveys effectively and ensure compliance. Learn more about Survey Readiness at SimiTree.  
  • Expert Witness Testimony: Leveraging our expertise to provide credible testimony when needed. 
  • Independent Review Organization for Corporate Integrity Agreements: Objective reviews to uphold corporate integrity. 
  • Staff Training and Education: Equipping your team with the knowledge and skills needed for compliance. 
  • Quality Measure and Star Rating Improvement: Strategies to enhance quality measures and star ratings. 
  • Performance Improvement: Guidance to improve overall performance in compliance and patient care. 

Questions? Fill out a contact form today to get in touch with an expert.  


Other ways to get in touch 

Contact us at 800.949.0388, visit SimiTreeHC.com, or email ContactUs@simitreehc.com to address all your compliance needs.  

SimiTree's experts bring a holistic approach, combining clinical, financial, and operational knowledge to fortify your organization against compliance and regulatory risks. Let us partner with you on the journey to success. 


Contact Us

Let's work together to improve the health of your organization. At SimiTree, we balance financial expertise and clinical excellence to help our clients grow. How can we help you? Call us at 866.839.5471 or complete the form below.