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

Anti-Kickback Compliance for Hospice and Skilled Nursing Providers

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 recent OIG guidance on hospice and skilled nursing facility relationships, focusing on anti-kickback risks and fraud concerns. They cover key issues such as the importance of documenting fair market value for any services or space provided, being cautious of payments exceeding Medicaid room and board rates, and avoiding arrangements that appear to be made solely to secure referrals. Bill and Jason also touch on increased oversight and enforcement in the healthcare sector under a new presidential administration.

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. 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 also delve into lessons learned, the importance of thorough documentation, and how to effectively prepare for administrative hearings.