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The Other Side of SSVI: What Hospice Leaders Should Watch Beyond Non-Hospice Spending
The Other Side of SSVI: What Hospice Leaders Should Watch Beyond Non-Hospice Spending Much of the industry discussion around CMS’s new Service and Spending Variation Index, or SSVI, has focused on non-hospice spending. But the utilization side deserves just as much attention. CMS is also looking at patterns such as long lengths of stay, high live-discharge rates, and beneficiaries returning to the same hospice shortly after discharge. Those patterns do not prove that a hospice made the wrong decision, but they can become flags that lead CMS to look more closely at the eligibility, recertification, and discharge decisions underneath the claims.
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Stop Looking for Decline. Start Seeing the Patient.
Stop Looking for Decline. Start Seeing the Patient. Every 15 days, federal regulation requires your interdisciplinary group to review each patient's plan of care. That's not a best practice. That's 42 CFR 418.56(d), and surveyors cite against it. What that review actually looks like inside a growing hospice is a lot less standardized than most leaders think. In plenty of organizations, IDT prep has quietly turned into a search. A nurse opens the chart hunting for evidence the patient is declining, because decline is what survives an audit. That's a poor use of a clinician's hour. It's also, and this is the part that usually gets missed, a poor compliance strategy.
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Why Operational Consistency Is Your Best Defense Against Hospice Audit Risk
Why Operational Consistency Is Your Best Defense Against Hospice Audit Risk Hospice organizations rarely struggle because clinicians make poor eligibility decisions. More often, appropriate decisions become harder to defend as documentation, clinical reasoning, and supporting evidence become less connected over time. Growth increases the number of patients, clinicians, locations, and decisions an organization must manage. Without a structured way to identify hidden gaps before they become exposure, decision risk quietly grows alongside the census.
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Beyond the Moratorium: Why Every Hospice Will Be Audited — and How to Be Ready
Compliance expert Sharon Harder (C3 Advisors) and Farrokh Abadi (CEO, Akssi) break down what auditors are looking for, the triggers that put hospices on the radar, and the documentation practices that reversed $147,000 in denials.
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The ROI of Getting Hospice Decisions Right the First Time
The ROI of Getting Hospice Decisions Right the First Time Hospice organizations pay for unsupported eligibility and recertification decisions twice. First through the time and labor required to fix documentation after the fact. Second through denials, clawbacks, and audit exposure when those same gaps repeat across claims. Hospice audit risk is primarily caused by decisions that are not fully supported by consistent, complete documentation. Most teams see the rework. The larger financial risk builds in the background. The real ROI comes from eliminating both.
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What the CMS Hospice Moratorium Signals About Audit Risk and Oversight
What the CMS Hospice Moratorium Signals About Audit Risk and Oversight CMS’s hospice enrollment moratorium is officially tied to fraud prevention and program integrity concerns. But for established hospice organizations, the larger issue is what the announcement signals about where hospice oversight is heading next and how quickly the operating environment is changing beneath it.
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Proactive Preparation for Provisional Period of Enhanced Oversight (PPEO) in Hospice
Proactive Preparation for Provisional Period of Enhanced Oversight (PPEO) in Hospice The compliance environment for hospice providers has shifted. CMS has intensified scrutiny of the hospice program in response to improper payments, suspected fraud, and rapid growth in certain markets. A central enforcement tool is the Provisional Period of Enhanced Oversight (PPEO), which places selected new hospices under heightened review that may include prepayment review of Medicare claims.
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Operationalized Insights: The Next Frontier in Healthcare Workflow Management
Operationalized Insights: The Next Frontier in Healthcare Workflow Management The healthcare industry generates massive amounts of data every day from electronic health records and digital health apps to monitoring devices and reporting tools. Artificial intelligence can now analyze this information and surface meaningful patterns and risks. When used effectively, these insights help reduce administrative burden, guide better decisions, and support safer, more consistent care across senior living, home health, and hospice environments.
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The Anatomy of a Defensible Hospice Recertification
The Anatomy of a Defensible Hospice Recertification
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