A Hospice's General Inpatient Audit Experience: At First, I Was Petrified

Following the OIG s recommendations, over the last years, the Center for Medicare and Medicaid (CMS) has focused much of its hospice auditing efforts on General Inpatient level of care (GIP) claims. In spring 2023, an hospice agency received notification of an audit of GIP claims. In response to the audit, the clinical and operational leadership team formed a task force that collaborated in GIP chart review and education. This task force started meeting weekly to discuss ongoing GIP patients, review opportunities for more accurate charting and discuss discharge options for patients who may need to change care settings. Faculty provided real-time education to all involved clinicians regarding GIP eligibility, appropriate documentation and counsel in proactive discharge planning. These interventions were of crucial importance in improving audit results: Of the first six claims audited for GIP appropriateness, only one patient was deemed to be eligible for all GIP days billed. The other five patients were either denied GIP payment or downcoded to Routine Hospice Care, resulting in drastic financial losses. The next batch of seven claims was deemed GIP appropriate and paid in full. Nevertheless, due to the low pass rate at the beginning, the audit was extended into round 2, which is ongoing at time of recording.  

This presentation provides an overview of the different CMS audits and shares a hospice agency s real-world experience with a GIP audit. Faculty reports on how their agency responded with ongoing chart review, staff education and increased collaboration with all partners in care of GIP patients. This includes sharing the charting review tool that was developed, and the educational interventions that were tailored to different interdisciplinary team members. Dos and don ts of GIP documentation are shared using examples from their audit experience as well as the appeals options and results.

Target Audience

Palliative care physicians, physician associates, APRNs, RNs, social workers, chaplains

Learning Outcomes

  1. Respond to a hospice GIP audit using strategies that foster both learning and audit success, utilizing a new chart audit tool developed for GIP patients.
  2. Applying  5 dos and don'ts of GIP documentation, demonstrate the ability to effectively collaborate with all partners in care regarding GIP eligibility and documentation.
Activity summary
Available credit: 
  • 1.00 ABIM MOC
  • 1.00 CME (physician only)
  • 1.00 Participation
Activity Published: 
11/14/2025
Activity Expires: 
02/29/2028
Member cost:
$49.00
List Price:
$64.00
Rating: 
0

Disclosures 
AAHPM endorses the Accreditation Council for Continuing Medical Education (ACCME) Standards for disclosure and commercial support and endeavors to ensure balance, independence, objectivity, and scientific rigor for all accredited products or programs. All who are in a position to control or influence the content of an educational activity must disclose any relevant financial relationships with ineligible companies.*Disclosure documents were reviewed for potential conflicts of interest and, if identified, were resolved prior to confirmation of participation. Only those who had no conflict of interest or who agreed to an identified resolution process prior to their participation were involved in this activity.
All editors, faculty and staff have disclosed no relevant financial relationships.

*An ineligible company is defined as any entity producing, marketing, reselling, or distributing healthcare goods or services consumed by, or used on, patients. 

Faculty
Martina Meier, MD
Claire Marie Santos, DNP RN
Rebecca L. Yamarik, MD MPH FAAHPM 
Eric Prommer, MD FAAHPM HMDC

Staff
Emily Geary, BA
Julie Tanner, BSN RN-BC CHPN
Julie Bruno, MSW LCSW

Continuing Medical Education (CME)

The American Academy of Hospice and Palliative Medicine (AAHPM) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The American Academy of Hospice and Palliative Medicine (AAHPM) designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit™.

Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion includes attesting to meaningful activity participation and completion/submission of activity evaluation within the time frame designated.

Evaluation period closes February 29, 2028 for claiming CME credit.

Maintenance of Certification (MOC) Recognition Statement

Through the American Board of Medical Specialties (“ABMS”) ongoing commitment to increase access to practice relevant Continuing Certification Activities through the ABMS Continuing Certification Directory, A Hospice's General Inpatient Audit Experience: At first I was Petrified apply toward general CME requirement for the following ABMS Member Boards:

  • Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1.0 MOC Medical Knowledge points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program.

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit. By submitting your evaluation, you grant AAHPM permission to submit completion information to ACCME for the purpose of granting respective BOARD MOC program credit or points as applicable. De-identified aggregated data from the evaluation may be used for research and/or publication and will conform to generally accepted standards of experimental design, data collection and analysis where indicated. 

Evaluation period closes February 29, 2028 for claiming MOC credit.

Available Credit

  • 1.00 ABIM MOC
  • 1.00 CME (physician only)
  • 1.00 Participation

Price

Member cost:
$49.00
List Price:
$64.00
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