In recent years, hospice providers across the nation have found themselves navigating a landscape marked by increased regulatory scrutiny and a surge in audit activities. The ramifications of simultaneous audits are far-reaching, posing significant challenges to hospice organizations striving to maintain quality care delivery while ensuring compliance with stringent regulations.

A recent survey conducted by prominent hospice industry organizations shed light on the pervasive nature of this issue. The survey, which garnered responses from 133 hospice providers, revealed a prevailing trend: the majority of hospices are now contending with multiple audits simultaneously. This confluence of audits typically encompasses a combination of Targeted Probe and Educate (TPE) audits alongside Supplemental Medical Review Contractor (SMRC) audits.

The focal point of these audits often centers on General Inpatient Care (GIP) utilization, with approximately 80% of audits honing in on this critical aspect of hospice services. However, it’s not just the frequency of audits that poses a challenge; it’s also the duration. Some audits extend over 18 months to two years, exacerbating the strain on hospice resources and personnel.

Providers Voice Concerns

Providers have voiced a litany of concerns regarding the audit process. Foremost among these concerns is the lack of transparency, consistency, and comprehension exhibited by audit contractors regarding hospice care. This opacity engenders inefficiencies and frustrations, as hospice organizations grapple with disputing findings and navigating the labyrinthine appeals process.

The implications of these challenges are profound. Hospice providers, already tasked with delivering compassionate end-of-life care, find themselves mired in administrative burdens and regulatory hurdles. The repercussions extend beyond mere inconvenience; they threaten to undermine the integrity of hospice operations and, ultimately, compromise patient care.

Stakeholders Advocate

In response to these pressing issues, industry stakeholders have proffered a slate of recommendations aimed at ameliorating the audit process. Chief among these recommendations is a call for enhanced transparency in audit procedures, coupled with a concerted effort to bolster audit contractors’ understanding of hospice care nuances. Additionally, stakeholders advocate for streamlining the appeals process and adopting a more tailored approach to oversight, one that targets instances of fraud and improper spending without ensnaring high-performing providers in bureaucratic quagmires.

Moving forward, collaboration between hospice organizations, policymakers, and regulatory bodies will be paramount. By fostering dialogue and implementing targeted reforms, stakeholders can forge a path toward a more equitable and efficient audit landscape—one that upholds the principles of accountability and quality care delivery while alleviating the burdens imposed on hospice providers.

Conclusion

The challenge of simultaneous audits looms large over the hospice industry, necessitating concerted action and thoughtful reform. By addressing the root causes of audit-related burdens and fostering a culture of transparency and collaboration, stakeholders can safeguard the integrity of hospice operations and ensure that patients receive the compassionate care they deserve, even amidst the rigors of regulatory scrutiny.

Source:

Parker J. [UPDATED] Nearly 53% of Hospices Undergo Multiple Audits Simultaneously [Internet]. Hospice News. 2024 [cited 2024 Mar 18]. Available from: https://hospicenews.com/2024/03/12/survey-77-of-hospices-undergo-multiple-audits-simultaneously/?euid=c7feb5fb2b&utm_source=hspn-newsletter&utm_medium=email&utm_campaign=7feac8f49d&mc_cid=7feac8f49d&mc_eid=c7feb5fb2b

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