CMS: Hospice Medication Claims Will Face Increased Scrutiny

CMS announced that Medicare claims for hospice medications will face heightened scrutiny from the agency in light of widespread inappropriate claims.

Medications for hospice patients should by and large be billed to Medicare Part A, with Medicare Part D only covering drugs that are needed for reasons unrelated to residents' terminal conditions. CMS believes that this guidance has been misinterpreted, resulting in Part D paying out $12.9 million in hospice claims for analgesics. These claims typically came from for-profit, new and/or rural hospice providers and half of the claims were for individuals receiving hospice care in nursing facilities.

To help remedy this, CMS plans to place prior authorization requirements on all hospice medication claims.

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