AGG Talks: Home Health & Hospice

The Impact of AI and Prior Authorizations on Home Health and Hospice

In this episode, AGG Healthcare attorneys Bill Dombi [https://www.agg.com/professionals/bill-dombi/] and Jason Bring [https://www.agg.com/professionals/jason-bring/] discuss the role of managed care, artificial intelligence, and prior authorizations in home health and hospice. Bill and Jason examine a recent lawsuit filed against a major Medicare Advantage plan in the United States District Court for the District of Minnesota challenging the use of AI-driven claims reviews in Medicare Advantage coverage decisions. They also address concerns around prior authorization denials, their high reversal rates, and potential consequences for providers and patient care.

Hospice Special Focus Program: Pumping the Brakes

In this episode, AGG Healthcare attorneys Bill Dombi [https://www.agg.com/professionals/bill-dombi/] and Jason Bring [https://www.agg.com/professionals/jason-bring/] discuss the hospice special focus program and CMS’ announcement that it will cease implementing the program in the face of litigation filed by providers and state associations.

OIG Report Reveals Gaps in Hospice PRF Compliance: What Providers Need to Know

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring [https://www.agg.com/professionals/jason-bring/] is joined by AGG Healthcare partner Alex Foster [https://www.agg.com/professionals/alexander-foster/] to discuss a recent OIG report highlighting Provider Relief Fund compliance issues within the hospice industry. Jason and Alex break down the origins of provider relief funds during the COVID-19 pandemic, the common pitfalls identified in the OIG report, and the importance of maintaining proper documentation. As government scrutiny increases, they provide practical steps for providers to prepare for potential audits, such as strategies for navigating lost revenue reporting, tracking expenses, and engaging legal counsel to ensure compliance under privilege.

Navigating the Audit Maze: Insights From Northeast Georgia Health System

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring [https://www.agg.com/professionals/jason-bring/] is joined by Kathy Barton [https://www.linkedin.com/in/kathy-barton-bsn-rn-chpn-14696648/] and Natalie McNeal [https://www.linkedin.com/in/natalie-mcneal-64ab47128/] of Northeast Georgia Health System in Gainesville, Georgia. Kathy and Natalie share insights on navigating the complexities of hospice audits, discuss their experiences with the appeal process, and offer practical strategies for success. They delve into lessons learned, the importance of thorough documentation, and how to effectively prepare for administrative hearings.

Understanding Palliative Care: Strategies for Compliance and Reimbursement

In this episode, AGG Post-Acute & Long-Term Care co-chair Jason Bring [https://www.agg.com/professionals/jason-bring/] is joined by AGG Healthcare attorney Charmaine Mech Aguirre [https://www.agg.com/professionals/charmaine-mech-aguirre/] to discuss the latest developments in the palliative care industry across the country. Jason and Charmaine talk through the key differences between hospice and palliative care, various models and approaches providers are adopting, and regulatory and reimbursement challenges. From state licensure requirements to compliance with the Anti-Kickback Statute, they provide valuable insights and practical advice for providers looking to expand or refine their palliative care services.