Face Challenges Confidently

Home Health And Hospice Agency Compliance With CMS

Wednesday, June 26th, 2019
healthcare attorneys help with more than litigation

Home health and hospice agencies must follow a large number of compliance laws along with staying in business. Having a good understanding of some of the biggest laws can help you and your staff stay up-to-date on compliance.

Compliance laws and issues for home health agencies

One of the biggest compliance laws for home health establishments comes from CMS. In November of 2018, CMS released a final rule dealing with payment rates and policies, as well as quality provisions. Some of the new changes, which will be implemented between 2019 and 2021, are meant to reduce the burden on CMS and those in the home health industry. They include the following but are complicated, so speaking with an attorney is vital to staying compliant.


  • Documenting the medical necessity of making a patient home visit instead of an office visit will not always be necessary.
  • Physicians can focus on paperwork changes when all relevant information is already on file, reviewed, and updated as needed.
  • Payment, documentation, and coding for inpatient/outpatient evaluation and management visits will be simplified.
  • There are additions of some add-on codes for specific situations like non-procedural specialized medical care and telehealth services.
  • There will be a change to the 60-day rule to avoid issues with the False Claims Act (FCA).

There are some steps you can take to ensure your agency is compliant with CMS. Your attorney can help you understand all of the regulations you must adhere to, as well as develop a compliance guide for all relevant staff.

  1. Create and implement a set of standards that all employees must agree to follow. Staff evaluations should include a review of their compliance.
  2. There should be an officer or committee that oversees compliance. They should be responsible for the management of your standards and keeping up with regulation changes.
  3. Training programs should be used to make sure everyone is aware of current laws and policies.
  4. Any offenses or fraud should be dealt with properly. If you do not handle these, your agency will be at risk of losing out on payments and potentially even licensing.

Compliance laws and issues for hospices

In order for hospice agencies to stay compliant with CMS, they must meet a specific set of standards. This is necessary even if they are part of a hospital, home health agency, or nursing home. The regulations are meant to prevent fraud as well as take better care of patients and their families. Here are some examples of changes that could affect hospices in the coming years.

  • Managing patients and understanding their needs will be more important, especially for preventing unnecessary treatments or transitions. This will help to reduce medical costs for
  • practitioners as well as overpayments from CMS.
  • Understanding care levels will prevent more work and costs within the hospice and CMS.
  • Staff will need to be more aware of changes to patient care plans and coding, review plans often, and pay more attention to reporting policies.
  • Quality of hospice care services may be more heavily scrutinized during surveys.

Hospice agencies can stay updated on changes to CMS compliance regulations by working with qualified attorneys. These professionals can help develop programs and make sure your policies are current. Like the steps above for home health agencies, all hospice staff should be current on regulations and undergo proper training regularly. Compliance should be monitored and any mistakes or fraud should be handled quickly.

How a healthcare attorney can help your practice

Whether you run a hospice or home health agency, having attorneys available to assist you is one of the best ways to stay compliant with CMS regulations and changes. They can help you with accreditation, operations, certification, audits, and reimbursement issues. If you need representation, a healthcare attorney can handle this as well.

In short, working with professional attorneys provides your practice with a multitude of benefits. To learn more about recent and upcoming changes to compliance laws, contact the Healthcare Team at Brown and Fortunato, P.C. today. You can reach us at (833) 228-6300 or Through Email for more information.