- Medicare Hospice Quick Reference Sheet
- Hospice Certifying Physician Medicare Enrollment Information
- Hospice Claim Reporting Requirements for Attending and Certifying Physicians
- 17729 and 17730 Hospice Claim Edits for Certifying Physicians
- Billing Hospice Transfers
- Hospice Notice of Election Termination/Revocation (Type of Bill 8xB)
- Hospice Room and Board Denials
- Professional Services During a Patient Hospice Election
- Incarcerated or Unlawfully Present in the U.S. Claim Rejections (U538H, U538Q)
- Termination of the Hospice Benefit Component of the VBID Model on 12/31/2024
- Provisional Period of Enhanced Oversight for New Hospices
- Counting 60-Day Election Periods
- Untimely Filed Notice of Election Circumstance Exception: Medicare Beneficiary Is Granted Retroactive Medicare Entitlement
- Hospice Billing Codes Chart
- Appropriate Use of Occurrence Code 27 and Occurrence Span Code 77
- Hospice Notice of Change of Ownership
- Filing an Electronic Notice of Change of Ownership (TOB 8XE)
- Hospice Change of Ownership
- Filing an Electronic Notice of Cancelation (Type of Bill 8XD)
- Filing an Electronic Notice of Transfer (Type of Bill 8XC)
- Counting 60-Day Election Periods - Leap Year
- Hospice Site of Service Codes
- Billing Hospice Physician, Nurse Practitioner and Physician Assistant Services (Related To Terminal Diagnosis)
- Hospice Visit Reporting
- The Medicare Hospice Benefit: Effects on Other Provider Types
- Counting 90-Day Election Periods - Leap Year
- Reporting Hospice Discharges, Revocations and Transfers
- Avoiding Reason Code 7C625: Appropriate Use of Remarks on Final Hospice Claims
- Hospice Claim Submission Job Aid
- Counting 90-Day Election Periods
- Hospice Quality Reporting Program
- Filing an Electronic Notice of Election (Type of Bill 8XA)
- Value-Based Insurance Design Model Hospice Benefit Component Overview
- Documentation for Hospice Transfers
- Hospice Billing Instructions for Influenza, Pneumococcal and Hepatitis B Vaccines
- Canceling a Hospice Notice of Election
- How to Bill When the Hospice Face-to-Face is Late from a Previous Benefit Period
- Billing Medicare for a Denial - Condition Code 21
- Reminder on Deleting Revenue Code Line(s) in the Fiscal Intermediary Standard System Direct Data Entry System
Provisional Period of Enhanced Oversight for New Hospices
In recent years, CMS has reported a significant increase in fraudulent hospice billing practices, which cost the Medicare program millions of dollars annually. The CMS has initiated a period of enhanced oversight for new hospices in Arizona, California, Nevada, and Texas which aims to curb fraud, waste, and abuse within the Medicare system as a direct response to these findings. These states were chosen based on data indicating heightened vulnerabilities in fraud, waste, and abuse in hospice care.
The criteria defining a new hospice include:
- Newly enrolled in the Medicare Program as of 07/13/2023.
- Submitted a CHOW that meets the regulatory requirements under 42 CFR 489.18. Underwent a 100% ownership change that does not qualify under 42 CFR 489.18.
- Reactivating after a period of deactivation.
Your hospice facility may be subject to this enhanced oversight if it fits any of the following conditions:
- Received final approval for Medicare enrollment on or after 07/13/2023.
- Began the enrollment or certification process before 07/13/2023, but has not yet received final approval from your MAC.
- Obtained approval for a change of ownership request on or after 07/13/2023.
The enhanced oversight will include medical reviews, such as prepayment reviews, and can last from 30 days up to a year, depending on the findings of CMS review and audits.
The goal of this oversight is to ensure compliance and protect the integrity of Medicare services provided by hospice care facilities.
If you have questions, email ProvisionalPeriod@cms.hhs.gov.
If you feel you have been put on the PPEO in error, please contact your local MAC provider enrollment department.
Related Content
- MLN Fact Sheet® Period of Enhanced Oversight for New Hospices in Arizona, California, Nevada, & Texas
- Code of Federal Regulations: 42 CFR 489.18
- CMS is Taking Action to Address Benefit Integrity Issues Related to Hospice Care
- NGS Provider Enrollment Contact Numbers
Posted 12/11/2024