NPHI met with CMS Administrator Seema Verma in mid September about the issues related to ongoing audits that are leading to claims being routinely denied based on an overly simplified conclusion that the documentation fails to show continuous “terminal decline”, as clinically defined by the MAC, ZPIC, and other contract reviewers rather than as clinically defined by and certified by the clinical judgment of the certifying physicians. These “rule of thumb” denials related to “terminal decline” are not aligned with the hospice statute nor with Medicare’s corresponding regulations. We requested that CMS assign a point person to work with us on guidance to its contractors that clarifies that payment denials strictly based a “terminal decline” requirement is not in accordance with the law and must cease.
NPHI Meets with Administrator Verma on Reducing Regulatory Burdens
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NPHI Calls on CMS to Enact Temporary Nationwide Moratorium on New Hospice Provider Enrollments to Stop Fraudulent Operators
[WASHINGTON, DC] – The National Partnership for Healthcare and Hospice Innovation (NPHI), representing the nation’s leading nonprofit, mission-driven, safety-net, hospice and advanced illness care providers,
Official Statement from NPHI on Recent Hospice Fraud Media Coverage and Ongoing Federal Enforcement Efforts
Background Recent national media coverage is focused on hospice and the Administration’s actions to address fraudulent providers, with stories appearing across major outlets. While some
Out Now: The NPHI 2025 Impact Report — A Decade of Impact and Laying the Groundwork for What Comes Next
Advancing Quality Care: NPHI & Our Members 2025 Impact Every day, nonprofit hospice and advanced illness providers across the country deliver high-quality care that brings
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