OIG’s Hospice GIP Audit Fueled by Inappropriate Billing; Nearly One Third of Claims Have Errors

Posted July 12, 2023

According to the U.S. Department of Health & Human Services (HHS) Office of the Inspector General (OIG), increased regulatory and clinical oversight is needed to address common billing and documentation errors related to hospice general inpatient care.

Inaccurate billing was among the driving forces behind the OIG’s recently announced nationwide audit of general inpatient hospice services (GIP), the regulatory watchdog stated.

Roughly one-third of Medicare claims for general inpatient hospice services (GIP) are billed in error, the OIG indicated. Common errors include billing for GIP services when hospice patients did not need this level of care.

“GIP care is solely for pain control or acute or chronic symptom management that cannot be provided in other settings,” OIG representatives told Hospice News in an email. “The report team completed some preliminary data analysis and selected a frame of claims believed to be at a high risk of misbilling. Our work has shown that in the past, hospices have inappropriately billed one-third of GIP stays, including billing for GIP care when the patient needed only routine home care or when the patient’s caregiver was not available and inpatient respite care was needed.”

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Are you a hospice provider who delivers GIP care? Are you prepared for the increased CMS focus in this area? As you are aware, the reimbursement rate for hospice general inpatient (GIP) care is the second-highest daily rate that Medicare pays for hospice services. Corridor documentation experts deliver industry-best quality chart audits in less time and at a lower cost than your staff. Free up your staff for core initiatives. We’ll take a deep dive into your records to ensure your documentation supports the appropriate level of care to support claim submission. Contact Us today to learn more.

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