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Hospice Quality Reporting Program Notices of Noncompliance and Reconsideration Requests

8.1.2017

The Centers for Medicare and Medicaid Services (CMS) has issued notification letters to hospice providers that are not in compliance with the Hospice Quality Reporting Program requirements. According to CMS, all noncompliance notices were dated July 18, 2017 and sent by mail and through the Quality Improvement and Evaluation Systems – Certification and Survey Provider Enhanced Reporting (“CASPER”) system. These notices are important because a determination of noncompliance could subject a hospice provider to a two (2) percentage point reduction in their upcoming Annual Payment Update (APU).

What can you do if you received a notice? First, a provider needs to review the letter carefully. Federal regulations allow a provider thirty (30) days from the date of the notice to request a reconsideration review. For the notices issued with a date of July 18, 2017, reconsideration requests must be submitted no later than August 17, 2017. The method to submit a reconsideration request is through email. CMS conducts its review based solely on the reconsideration request and accompanying documentation. Therefore, it is essential, and required, that providers submit documentation demonstrating compliance with the Quality Reporting Program requirements with their reconsideration request. The CMS Hospice Reconsideration Request webpage, provides helpful examples of documentation that would support compliance, along with examples that would not demonstrate compliance. A provider should review those lists to ensure that it provides the necessary documentation to support its reconsideration request. CMS will not review reconsideration requests submitted without the necessary supporting documentation.

When preparing a request for reconsideration, review the instructions in your notification letter and on the CMS Hospice Reconsideration webpage for the information required to be submitted. Review the request carefully to make sure that information is accurate (for example, make sure that the Hospice CMS Certification Number (CCN) is correct). Also, the email reconsideration request is not a secure transmission so do not submit any protected health information or patient lists with your reconsideration request. Any transmission of protected health information with the emailed reconsideration request could lead to violations of the Health Insurance Portability and Accountability Act (HIPAA) by a provider.

CMS should acknowledge receipt of the reconsideration request through an email. Following its review of the request and supporting documentation, CMS will issue its decision by regular mail either upholding or reversing the finding of noncompliance. If the decision upholds the finding of noncompliance, a provider may file an appeal with the Provider Reimbursement Review Board.

If your agency has received a notice of noncompliance, review the notice and instructions immediately and be ready to act.

If you have questions about any of the above information, Iain Stauffer is available by email at istauffer@poynerspruill.com to provide assistance.

Physical Address: 301 Fayetteville Street, Suite 1900, Raleigh, NC 27601

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