This transcript has been auto generated
00;00;00;00 - 00;00;39;26
Bryan Nowicki
Hello and welcome to Hospice Insights: The Law and Beyond, where we connect you to what matters in the ever changing world of hospice and palliative care. Bottom Line, Top of Mind: Compliance Checklist for Hospice and Home Health. Andrew and Josi, welcome. I'm glad. I'm glad you're here. As you know, I'm getting my feet wet with the whole podcast hosting duties, so, I could use as much help as I can get from our super qualified team, and and, you two guys are the best at what you do.
00;00;39;26 - 00;00;43;12
Bryan Nowicki
So thanks for sharing what you have to share with us today. Really appreciate.
00;00;43;12 - 00;00;50;05
Andrew Brenton
It. Thank you. Bryan. Yeah, very, very happy to be here. And yeah, love the podcast. I'm happy to have Josi with us here as well.
00;00;50;08 - 00;00;51;22
Josi Wergin
Great. Likewise. Thanks for having us.
00;00;51;22 - 00;01;19;16
Bryan Nowicki
Yeah. You're welcome. So. So this is an interesting podcast. And it's an interesting kind of new way that our team has approached, what I think is an area of a lot of interest and need, that we encounter across a lot of what our team does. I mean, our team is really the one stop shop for hospice and home health, whether it's audits or regulatory or enrollment or any manner of that.
00;01;19;16 - 00;01;44;04
Bryan Nowicki
And we represent hundreds of them across the country. So we have that special insight into what are the issues that those providers are dealing with. And, Andrew, Josi, you came up with a way to help share that insight in a very practical way through these compliance checklists. So I'm excited to hear more about these. And when I first hear the word compliance.
00;01;44;04 - 00;02;14;23
Bryan Nowicki
And 20 years ago when I started doing presentations for hospices, at the time, one of the first things I presented on was the seven elements of an effective compliance program. So I kind of always go back to that foundational item, which is, you know, a few decades old, and I think they're in the process of updating. But why don't you tell me these checklists, compliance checklists you've developed, how do they fit into those seven elements of an effective compliance program?
00;02;14;24 - 00;02;15;16
Bryan Nowicki
Andrew. Yeah.
00;02;15;17 - 00;03;03;06
Andrew Brenton
Well great question. Yeah. The seven elements, you know, kind of the developed or put out there by the OIG, kind of more provide a general structure for really any type of health care provider organization to, kind of, you know, structure their, their compliance program. So that's kind of more about process, more about organizational structure. Our compliance checklists, focus on discrete substantive issues, issues that in our experience representing hospices and home health, agencies, you know, kind of commonly come up, could commonly trip up providers, kind of have a potential to impact payment, you know, so it's kind of the difference really is more about structure versus kind of discrete, substantive
00;03;03;06 - 00;03;05;25
Andrew Brenton
examples that kind of fit within that structure.
00;03;05;25 - 00;03;25;13
Bryan Nowicki
Okay, great. And we will be sharing eventually in this podcast and in the notes away for folks who are interested in these checklists and some of the other related tools to reach out to us and discuss them, or obtain them. So we'll get to that. But but, Josi, why don't you get us started? Tell us what these checklists, look like.
00;03;25;13 - 00;03;26;03
Bryan Nowicki
What are they all about?
00;03;26;03 - 00;03;58;04
Josi Wergin
Sure. We've developed two checklists. One is for hospice and one is for home health. And we identify on those checklists, 14 to 15 of some of the most important compliance issues for each of those issues, the checklists suggest first, actually they start with a description of what is the issue and generally speaking, why it's important. Potential consequences. And then for each of those items, the checklists suggest a few key action items that organizations can implement in order to address that issue.
00;03;58;04 - 00;04;24;11
Josi Wergin
And a lot of times we're focusing on what can you do to proactively prevent these problems from arising and be ready to respond in case they do occur. So we've also, you know, thinking of this being a usable checklist with action items. In addition to the checklists, we also developed templates, spreadsheets that organizations can use to prioritize and track their progress in implementing the action items.
00;04;24;13 - 00;04;57;29
Josi Wergin
And these templates will kind of have the topics and the action items pre-filled. But organizations can always add more items. They can add more action items, they can add more topics however they want to use them. They're completely editable. And you can also add or delete columns for tracking purposes. So some of the columns that we have are what's the status, what's the priority level, who's responsible for it, target and actual completion dates, frequency of how often you want to come back and look at this issue.
00;04;58;06 - 00;05;12;24
Josi Wergin
And basically areas where you can put links to related policies, procedures or documentation. So there's a lot of useful things you can use in there. And then you can also add columns if there's additional things that you want to track.
00;05;13;00 - 00;05;34;29
Bryan Nowicki
Well the the hospice and home health providers we work with as they know as, as the three of us certainly know, there are hundreds, thousands of regulations that are out there that, you may need to be where you should be mindful of, and that the government expects compliance with, but these checklists, I've looked at them.
00;05;34;29 - 00;05;45;13
Bryan Nowicki
They're not hundreds of pages long, or anything like that. So how did you kind of, decide upon what the focus of these particular checklists and tools would be?
00;05;45;18 - 00;06;17;01
Josi Wergin
Right. So we focused on compliance program problems that can have a big impact on the organization's bottom line, or their ability to keep operating and get get paid or the services they provide. So examples of things would be issues that might affect whether the organization will be fully paid for the services it provided, whether it might be subject to substantial financial penalties, or whether it might be barred from participating in a payment program.
00;06;17;01 - 00;06;43;27
Bryan Nowicki
Yeah, I mean, those are all the big issues that that our team I know deals with on a daily basis through audits, through enrollment, and other things that, sometimes on these audits, it's bet the company stuff where it could mean, are you going to be able to continue operating. So so good. These are these are kind of those kinds of very consequential issues that we're digging into the weeds a little bit to help, help providers out.
00;06;43;29 - 00;07;07;20
Bryan Nowicki
What about issues that are not necessarily focused on home health or hospice but have broader application? I'm thinking of, HIPAA requirements, which go across any kind of provider type or employment law. And people have to deal with that with their HR department. How are those dealt with or do they do those are those included in and among the items reflected in the checklist?
00;07;07;21 - 00;07;31;21
Josi Wergin
Those are issues that are absolutely still important, and they certainly can have a big impact on the bottom line. To give an example of one that you mentioned, a really large HIPAA breach could be costly, both in terms of internal resources and external costs and resources, and the impact can come from a lot of different, avenues. It could be civil monetary penalties.
00;07;31;21 - 00;07;58;13
Josi Wergin
It could even be class action lawsuits. Attorneys generals could get involved. So it's really there could be very big financial impact with other compliance issues. But these checklists really focus on compliance issues that have a closer nexus to payment and your ability to participate in government payment programs, because that's really your that's your cash flow that you use in order to keep operating and keep serving people.
00;07;58;14 - 00;08;22;00
Bryan Nowicki
All right. Great. Well Andrew there's two checklists here. There's a hospice and then there's a home health. I know we represent both kinds of providers, and increasingly more in the home health than even, other providers that, provider types that hospices have migrated into. We've, we've grown along with our clients over the past 20, 25 years in that way.
00;08;22;02 - 00;08;34;29
Bryan Nowicki
So are there common areas that affect both hospices and home health entities? And then what where does the split happen and across what kinds of topics? Is there some divergence between these checklists?
00;08;34;29 - 00;09;03;16
Andrew Brenton
Yep. Yeah, absolutely. I would say maybe half of the, kind of items on each checklist kind of overlap with each other. I just give in kind of, similar issues that hospices and home health agencies and, you know, oftentimes any provider are going to be dealing with so have common items would be things related to like Medicare, Medicaid, provider enrollment, you know, licensing issues.
00;09;03;18 - 00;09;24;14
Andrew Brenton
The anti kickback statute, the Stark Law for home health, had, you know, fraud and abuse type issues, you know, kind of structuring relationships with referral sources, you know, obviously hospice and home health are both both, post-acute care providers. So kind of dealing oftentimes with the similar with, you know, similar fraud and abuse type issues.
00;09;24;14 - 00;09;57;28
Andrew Brenton
So, right, that kind of broad summary, I suppose, of the common issues. But then, yeah, obviously each provider type is heavily regulated on its own, have unique, requirements. So the divergence, really is kind of where did it get specific to each provider type. So right with hospice we have the election statement. Of course, you know, that is a perennial, you know, kind of compliance focus both on audits and, you know, and repayment investigations.
00;09;58;00 - 00;10;21;15
Andrew Brenton
You know, the, certification of terminal illness, hospice caps. Right? We get into that in the checklist. That's obviously not, you know, an overlap with home health. And then on the home health side. Right. We a deal with Oasis, we I deal with, notice of admissions, electronic visit verification. Right. Things that don't and wouldn't impact hospice.
00;10;21;15 - 00;10;27;19
Andrew Brenton
So, yeah, that has sort of, overview of the kind of common items and then the divergent items.
00;10;27;24 - 00;10;46;09
Bryan Nowicki
Yeah, there's some areas where it's like the similar subject matter but treated differently by each one, like hospice eligibility and home health eligibility. It does a patient have a six month prognosis or is a patient homebound? I mean, those are two clinical measures or those dealt with in these checklists.
00;10;46;10 - 00;11;05;17
Andrew Brenton
Yes. Yeah, exactly. So that yeah, that's sort of maybe like a hybrid example because right. To your point and a similar and theme. Right. Dealing with eligibility. But as you get down to the specific provider type then we get the divergence. You know, hospice criminality, health, homebound. So yes.
00;11;05;17 - 00;11;38;18
Bryan Nowicki
Yeah. And just kind of looking through that, the checklists and the topics they covered, I think both you and Josi mentioned, you know, there's, there's, you know, 13, 14, 15 subject areas. And just to, to kind of get a sense from people who are listening and can't really see what we're talking about yet. That goes from agency licensing and provider enrollment, fraud and abuse, background checks, personnel licensure and scope of practice, verification of physician Medicare enrollment, contractual or payment agreements, surveys.
00;11;38;20 - 00;12;03;19
Bryan Nowicki
And this is for hospice. I think we're getting into elections clinical eligibility plan of care. The technical aspects of documentation. Consolidated building hospice caps, hospice quality reporting system. You guys are are taking a a a broad look at a lot of topics. But then you kind of look at this document and it gets into the weeds in areas that are familiar to me, because I know we have clients coming to us with these issues.
00;12;03;19 - 00;12;03;28
Bryan Nowicki
Yeah.
00;12;03;29 - 00;12;20;14
Andrew Brenton
Yeah, that's exactly right. Gets into the, the weeds and, and also kind of, you know, trying to provide actionable items for, right, for compliance staff to kind of deal with these issues. So trying to also kind of be practical and operationally focused as well.
00;12;20;14 - 00;12;49;14
Bryan Nowicki
Great. Well, I think this is a great platform for people to to take a look at. And Josi, you described the checklists, how they're really customizable for people, you know, as they encounter new issues to add to them or what is particular to their, their, their organization, and how they can, can review it. So, Josi, how how do folks, how are they able to get a copy of the checklist and the, tracking tool that goes with it?
00;12;49;15 - 00;13;07;10
Josi Wergin
You can send an email to the email address that's in the description for this podcast. Wherever we're posting the podcast, we're also including the email address. And then just let us know if you'd like the hospice checklist and spreadsheet, the home health checklist and spreadsheet or both, and we'll be happy to send them to you. All right.
00;13;07;10 - 00;13;15;29
Bryan Nowicki
Great. Any any final words, relating to this really, I think innovative, useful, useful checklists for, for, the providers out there.
00;13;16;00 - 00;13;39;07
Josi Wergin
I think, like you mentioned at the beginning, the seven elements of a, an effective compliance program, this is not only addresses some of the specific things that the OIG highlighted in its updated compliance program guidance, such as anti kickback and Start considerations, fraud, waste and abuse and things like that. As Andrew mentioned, we're also zeroing in on some of the hospice and home health specific things.
00;13;39;13 - 00;14;09;18
Josi Wergin
And it really fits into your compliance structure, particularly element number six which is where you're looking at risk assessment and setting up processes for auditing and monitoring. The risk assessment shouldn't just be these checklists and templates and spreadsheets and things like that. Because as we discussed, there's other issues to consider. But hopefully this will help provide some structure to helping organizations look at the really bottom line affecting payment, affecting issues.
00;14;09;21 - 00;14;19;01
Josi Wergin
That can have a huge impact, even if they, the individual problems might start out small or might be small, they can really snowball and have a big effect.
00;14;19;01 - 00;14;44;14
Bryan Nowicki
Yeah. And I think, when I've represented hospices, home health agencies, which is often when they're under the microscope, and we're kind of defending them as high quality providers who got swept up in the, the broad net, the wide net that CMS casts. I'm very happy if we're able to demonstrate to the government we have a real robust compliance program.
00;14;44;16 - 00;15;07;05
Bryan Nowicki
It's organized, it's methodical. And having something like this, it really, I believe, increase is the confidence and trust that the government will have in you because you're there's evidence that you're policing yourself. And even if you have to make repayments, that's not always a bad thing. It shows you're being proactive. You find issues, you address them, you do what's right.
00;15;07;11 - 00;15;26;10
Bryan Nowicki
And so again, I'd love to be able to have a tool like this for all our clients if we're ever investigated by the government. And they say, why should we believe that you're doing things the right way and we can kind of pull out this checklist and say, well, here's why. Because this is a great tool. It's methodical and we're keeping up to it.
00;15;26;10 - 00;15;32;03
Bryan Nowicki
So Andrew, do you have the last words? Any parting parting comments?
00;15;32;05 - 00;15;58;19
Andrew Brenton
Well, I like how you you kind of tied it back to, kind of where we started, which was right. The seven elements of an effective compliance program. So, yeah, I think these tools hopefully will kind of help, you know, providers implement, you know, those elements and, you know, kind of be equipped with some, you know, specific tools for addressing, some of the top compliance issues that were obviously, you know, all right.
00;15;58;19 - 00;16;24;22
Bryan Nowicki
Great. Well, Andrew, Josi, thanks once again. This is this is great stuff. And, I know you both have a wealth of experience and it really shows and shines through in this document. We're happy to share that with folks out there. So, if you want to talk with any of us about these issues, whether it's in a broad sense of just compliance and how to track issues generally, or you got a particular issue, you're you're maybe it's a brain teaser.
00;16;24;22 - 00;16;45;27
Bryan Nowicki
You need to do some troubleshooting. I can't think of two better people than Andrew and Josi to, to pick their brains on these. These are the people that I turn to initially when I get a tough question. So thanks again for being here. And everybody else that's, listening. Take care. That's it for today's episode of Hospice Insights: The Law and Beyond.
00;16;45;29 - 00;17;02;11
Bryan Nowicki
Thank you for joining the conversation. To subscribe to our podcast, visit our website at huschblackwell.com or sign up wherever you get your podcasts. Until next time, take care.