Adviser LeadingAge New York Winter 2014 Winter 2014 | Page 36

ENHANCING PARTNERSHIPS

35

Hospice Medications and Medicare
Part D in the Nursing Home
By: Richard Tinger, R.Ph., senior vice president of business development ,
Avanti Health Care Services and Virginia Arbour, director of finance for The
Community Hospice

C

enter for Medicare and
Medicaid Services (CMS
has always been concerned with
hospice and relationships with
the nursing home. They have
always been suspect of duplicate
services and now they are focusing
on whether drugs covered under
Part A Hospice Benefit are being
billed to Part D inappropriately.
According to analysis performed
on behalf of CMS in 2010, of more
than 750,000 hospice patients
enrolled in Part D, 15 percent
received analgesics through Part D
totaling almost $13 million.
Analgesic billing was concentrated
among certain types of hospices.
Ten percent of the hospices
accounted for over 50 percent of
the part D analgesic claims. These
hospice providers were typically
for-profit, new and or rural. Over
50% of the claims for analgesics
were for hospice patients residing
in nursing facilities.
Services covered under th B