Hospice Audit Series

Audits are a fact of life for hospices—it’s not a matter of “if” a hospice will be audited, but “when.” The alphabet soup of audits has expanded, from UPICs to SMRCs, CPIs, TPEs and more. With the hospice carve-in to Medicare Advantage, MAO audits will join the list. The recent pause in audits as a result of the COVID pandemic hints at increased activity as the pandemic wanes. In this series, Meg Pekarske and Bryan Nowicki of Husch Blackwell’s Hospice Audit team deconstruct the most recent developments in hospice audits, providing insight and guidance on the why, when and how of audits and—most importantly—what hospices can do about it.

Today’s Episode | Painting the Picture: How to Advocate for Clinical Hospice Eligibility in the Audit Appeal Process

The core of most hospice audits has been, and continues to be, whether the medical record supports the patient’s hospice eligibility. In this episode, Husch Blackwell’s Meg Pekarske talks with Bryan Nowicki and Zaina Niles about strategies for showing how a medical record supports a patient’s six-month prognosis. Tune in here: https://www.huschblackwell.com/newsandinsights/hospice-audit-series-painting-the-picture-how-to-advocate-for-clinical-hospice-eligibility-in-the-audit-appeal-process

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Photo of Meg S.L. Pekarske Meg S.L. Pekarske

Meg has devoted her legal practice to serving the everchanging legal needs of the hospice industry. As chair of Husch Blackwell’s Hospice and Palliative Care Practice Group, she manages the firm’s hospice practice. In working day in and day out with hospice clients

Meg has devoted her legal practice to serving the everchanging legal needs of the hospice industry. As chair of Husch Blackwell’s Hospice and Palliative Care Practice Group, she manages the firm’s hospice practice. In working day in and day out with hospice clients across the country, Meg is intimately familiar with the operational challenges of hospices and has the experience to address the full spectrum of legal issues facing the industry, from routine regulatory compliance issues to multimillion dollar Zone Program Integrity Contractor (ZPIC), Medicaid and other government audits. Additionally, Meg routinely advises hospices on palliative care program development, innovative inpatient unit structures, fraud investigations and a wide range of contracting issues. With an extensive background in long-term care, Meg brings a unique perspective and skill set to helping hospices create successful partnerships with nursing homes and assisted living facilities and providing quality end-of-life care to patients.

Photo of Bryan K. Nowicki Bryan K. Nowicki

I lead the litigation and internal investigation efforts within Husch Blackwell’s Hospice and Palliative Care Practice Group. I work with hospices and healthcare providers across the country on a range of litigation, regulatory, compliance, and business matters. I represent clients in False Claims…

I lead the litigation and internal investigation efforts within Husch Blackwell’s Hospice and Palliative Care Practice Group. I work with hospices and healthcare providers across the country on a range of litigation, regulatory, compliance, and business matters. I represent clients in False Claims Act lawsuits, state and federal government fraud investigations, and audits by Zone Program Integrity Contractors (ZPICs), Medicare Administrative Contractors (MACs), and Medicaid Integrity Contractors (MICs). I also conduct and manage internal investigations of hospices and health care providers regarding a range of compliance matters.

Photo of Zaina Niles Zaina Niles

Zaina is part of the firm’s Healthcare Regulatory & Compliance Counseling​ ​team, which advises a wide range of clients on ​how to mitigate risk and ensure compliance​ in the ever-changing healthcare field. In addition, she works alongside the firm’s Hospice & Palliative

Zaina is part of the firm’s Healthcare Regulatory & Compliance Counseling​ ​team, which advises a wide range of clients on ​how to mitigate risk and ensure compliance​ in the ever-changing healthcare field. In addition, she works alongside the firm’s Hospice & Palliative Care Team to guide hospice providers ​through each stage of the audit and appeal process.