ZPIC announces increased Part B scrutiny for physicians referring to hospice
Tuesday, August 20, 2013
by: VNAA Policy Team

Section: Public Policy and Advocacy




On August 12, AdvanceMed, the Zone Program Integrity Contractor (ZPIC) for Zone 5, announced a benefit integrity review of providers referring Medicare beneficiaries to hospice agencies. AdvanceMed provided advanced notice through a memo to the Part B provider community that referring providers will be under increased scrutiny for referrals to hospice providers.

The memo reiterates hospice eligibility requirements:

  • The beneficiary must be entitled to Medicare Part A.
  • The beneficiary must be certified as being terminally ill.
An individual is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is six (6) months or less if the illness runs its normal course.

The memo also reviews the specific requirements for certification, re-certification and the face-to-face encounter.

The states covered by the Zone 5 ZPIC include Alabama, Arkansas, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia.

A copy of the AdvanceMed memo to Part B providers can be found at by clicking here.
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