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Hospice News

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CMS Offers Hospices Three-Month Grace Period on Addendum Rule

Hospices are now required to give every patient an addendum to the election statement explaining what is and isn't covered under the Medicare Hospice Benefit, a requirement that took effect October 1, 2026 under the FY2027 hospice payment rule. Previously, hospices only had to provide the addendum upon request. CMS announced it will exercise enforcement discretion through December 31, 2026, during which Medicare Administrative Contractors will not deny claims solely for a missing or incomplete addendum, instead focusing on provider education. After that date, hospices that fail to comply face claim denials and increased regulatory scrutiny. Advocacy group NPHI has raised concerns that the mandate creates undue administrative burden with limited patient benefit.

hospicenews.com

Industry·3d ago

Lawyers Warn AI Fraud Tools Lack Human Oversight in Hospice Audits

In a two-part investigative series, Hospice News reports that legal experts are raising concerns about insufficient human oversight in AI-driven hospice fraud enforcement. Attorneys Edo Banach (Foley Hoag) and Howard Young (Morgan Lewis) say CMS contractors are using AI tools to select hospices for audit and process rebuttals, sometimes producing responses with apparent AI "hallucinations" that get reversed once humans review them. CMS's proposed CRUSH initiative, along with AI-driven data mining by the FBI, HHS-OIG, and DOJ's National Fraud Detection Center, are scrutinizing billing anomalies like long lengths of stay and high recertification volumes, with recent revocations concentrated in Arizona, California, Nevada and Texas. CMS did not respond to requests for comment on its AI oversight practices.

hospicenews.com