Course Code: REL-PAC-WB-MSOHBMRA
Hours: 1.5
Type: Online Course
Content Expiration Date: 12/31/2026
Learning Objectives:
Identify recent regulatory changes designed to decrease Medicare spending outside the Medicare Hospice Benefit.
Recall the hospice physician relatedness determination process.
Name three risk mitigation strategies to ensure compliance with Medicare spending outside the Medicare Hospice Benefit.
Outline:
Learning Objectives
CMS’ Expenditure Outside the Medicare Hospice Benefit
Hospice Benefit Background (FY 1983)
Hospice Benefit Background (FY 2014)
Hospice Benefit Background (FY 2014) Cont’d
Relevant Regulatory Changes (FY 2015 to Present)
Relevant Regulatory Changes
CMS’ Expenditure Outside the Medicare Hospice Benefit
OIG Audit Findings (Nov 2021)
OIG Audit Findings (Nov 2021) Cont’d
CMS’ Expenditure Outside the Medicare Hospice Benefit
Key Takeaways: For CY 2010-2019
Nonhospice Payment Breakdown
Nonhospice Payments and GW Modifier
Payments and Profit Status Comparison
OIG Audit Findings (Feb 2022) Cont’d
Risk Mitigation: Minimizing Spending Outside the Medicare Hospice Benefit
Patient/Representative Election of Hospice Care
Explain the “What Ifs”
Patient/Representative Designation of Attending Physician
Attending Physician Definition
Attending Physician: Caution
Attending Physician: Risk Areas
Patient Diagnoses and Relatedness Determinations
Patient Diagnoses
Relatedness Determinations
Identify the Principal (Terminal) Hospice Diagnosis
Election Statement Addendum (FY2020)
Election Statement Addendum (Sample)
Medication Relatedness
NF/SNF Patients: Medicare Part D
Medicare Claim Processing
Next Steps
Q&A Time
Subject Matter Expert: Carrie Cooley, RN, MSN
Carrie Cooley is the Principal of Weatherbee Resources. Carrie joined Weatherbee in 2009 as an Associate Consultant and was hired as the Consulting Coordinator in 2012. In 2014, Carrie was promoted to the Director of the Consulting Division and in July 2015, she assumed the Chief Operating Officer position. Carrie was promoted to CEO in February 2018.
In August 2021, Carrie became the sole owner of Weatherbee Resources having purchased the company with a business partner in 2018 from the company’s founders, Heather Wilson and Joy Barry. Carrie continues the long-standing history of Weatherbee Resources’ service to the hospice community.
In her role as Principal, Carrie ensures Weatherbee’s consulting services, products, and education are provided in a professional and cost-effective manner and are specifically tailored to meet each client’s individual needs. As one of Weatherbee’s owners, Carrie is responsible for ensuring Weatherbee is positioned to assist hospices with the ever-changing regulatory hospice environment.
Carrie’s regulatory expertise and extensive consulting experience includes forensic clinical record auditing, baseline compliance audits/mock surveys, interim management, clinical due diligence, and executive coaching. Carrie and her team also work directly with clients’ legal counsel in preparation for arbitration and other hearings; Carrie frequently serves as an expert witness. Weatherbee also works extensively with clients who are under a Corporate Integrity Agreement (CIA); Carrie and her team manage the Independent Review Organization (IRO) audit activities required by the Office of Inspector General (OIG). Carrie’s excellent rapport with executives and staff alike – coupled with her regulatory and clinical acumen, and knowledge of best practices – assures excellent consulting outcomes.
Under Carrie’s leadership, Weatherbee has assisted hundreds of clients under investigation by various Medicare contractors including: Targeted Probe and Educate (TPE), Zone Program Integrity Contractors (ZPIC), Unified Program Integrity Contractors (UPIC), Benefit Integrity Support Centers (BISC), Recovery Auditors (RA), the Department of Justice (DOJ), and the OIG.
As a member of Weatherbee’s Speaker’s Bureau, Carrie teaches a broad range of hospice, regulatory, and leadership-related topics nationally and is a member of the faculty for Weatherbee’s renowned Hospice Regulatory Boot Camps. Carrie also frequently speaks at state and national hospice conferences on compliance-related topics.
Carrie is a registered nurse and holds a master’s degree from Samford University with a specialty in nursing leadership and healthcare finance.
Target Audience:
The target audience for this course is: Nurses; in the following settings: Hospice.
Relias Learning will be transparent in disclosing if any commercial support, sponsorship or co-providership is present prior to the learner completing the course.
Relias Learning has a grievance policy in place to facilitate reports of dissatisfaction. Relias Learning will make every effort to resolve each grievance in a mutually satisfactory manner. In order to report a complaint or grievance please contact Relias Learning at support@reliaslearning.com.
All courses offered by Relias Learning, LLC are developed from a foundation of diversity, inclusiveness, and a multicultural perspective. Knowledge, values and awareness related to cultural competency are infused throughout the course content.
To earn continuing education credit for this course you must achieve a passing score of 80% on the post-test and complete the course evaluation.
Course Delivery Method and Format
Asynchronous Distance Learning with interactivity which includes quizzes with questions/answers, and posttests.