In This Section
Regulatory A to Z

Listing of Regulatory Topics. Hospice Acronym Index.

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Beneficiary Notices and Coverage (ABN NOMNC)

Advance Beneficiary (ABN). Notice of Medicare NonCoverage (NOMNC). Detailed Explanation of Non-Coverage (DENC).

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Billing and Reimbursement

Resources for Medicare billing, physician and NP billing and reimbursement. Medicare and Medicaid Rates. Hospice Cap. Hospice cost report. Q Codes.

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Certification and Recertification

Technical Requirements for Certification, Recertification, Physician Narrative, Face to Face, Attestations. Signatures.

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Data Sources

Data to assist in identifying risk areas. MedPac. NHPCO Facts and Figures. PUF. PEPPER. Proposed Rules.

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Discharges, Transfers, and Revocations

Discharge No Longer Terminal. Discharge Leave the Service Area. Discharge For Cause. Revocation. Transfer (Change) of Designated Hospice Provider. Traveling Patients.

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Election and Admission

Requirements for a Medicare Hospice Election Statement. Election Statement Addendum. Initial and Comprehensive Assessments. Notice of Election (NOE).

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Emergency Preparedness

Emergency Preparedness and CMS. Coronavirus (COVID-19) Public Health Emergency.

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Facility Based Care (SNF, NF and ALF)

Hospice Care in Skilled Nursing Facilities (SNF). Nursing Facility (NF). Assisted Living (ALF) and ICF/IID. Q Codes.

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HIPAA

HIPAA Requirements. Information Blocking Rule.

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Interdisciplinary Team (IDT/IDG) and Care Planning

This section provides regulatory resources on the roles of the IDT, core services, medical directors versus other hospice physicians, hospice aide supervision, and the hospice plan of care.

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Levels of Care

Routine Home Care. General Inpatient Care. Inpatient Respite Care. Continuous Home Care. Q Codes.

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Medical Review and Audits

Medical review entities: Medicare Administrative Contractors (MACs). Unified Program Integrity Contractors (UPICs). Recovery Auditors (RA). Special Medicare Review Contractors (SMRC).

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Medicare Hospice Regulations and Federal Resources

Regulations and links to important CMS and other Federal Regulations and Resources. Medicare Conditions of Participation. Medicare Conditions of Payment. Medicaid.

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Opioids

Prescribing. Drug Disposal.

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Pediatrics

Pediatric Palliative and Hospice Care. Concurrent Care. TRICARE.

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Program Integrity

OIG. OIG List of Excluded Individuals/Entities (LEIE). Fraud and Abuse. Compliance Program Guidance. CMS Fraud and Abuse Contractors. NHPCO Compliance Certificate Program.

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Regulatory and Policy Alerts and Updates from NHPCO

Find NHPCO Regulatory Alerts and Updates. Comment Letters. and Publication Links of importance.

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Regulatory and Quality Office Hours

A monthly opportunity for members to have their regulatory questions answered.

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Relatedness: Conditions, Medications, Drugs, Services

Related and Unrelated Conditions, Medications, Drugs and Dervices. Hospice and Part D.

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Special Focus Program

The Hospice Special Focus Program (SFP) is a program conducted by CMS to identify hospices as poor performers, based on defined quality indicators, in which CMS selects hospices...

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State Specific Resources

State Regulations and Laws. Certificate of Need Comparison.

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Survey Readiness and Response

Medicare Survey Process. Survey Readiness. Survey Response. Plan of Correction. Top Survey Deficiencies. Enforcement Remedies.

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Terminal Illness and Related Conditions, Prognosis, and Eligibility

Terminal Illness. Related Conditions. Eligibility. Local Coverage Determinations. ICD-10.

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Volunteer Services

Orientation and Training. Recruitment. Retention. Cost Savings. Counting Hours for 5%.

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