Medical Review in the Hospice Medicare Certified World

  • Room: 260/267
  • Session Number: 607
Tuesday, October 25, 2022: 11:00 AM - 12:00 PM


Leslie Heagy RN
Director of Clinical Services
Healthcare Provider Solutions, Inc.
Melinda Gaboury COS-C
Chief Executive Officer
Healthcare Provider Solutions, Inc.


Hospice is on the hot bed of Medical Review in 2022. This session will take agencies through the winding road of Medicare scrutiny. While billing the Medicare benefit and getting paid relatively easily, there is always a risk of things being reviewed at some point and what can you do to avoid denials. This session will also discuss PEPPER reports and other data analysis that agencies will need to review to ensure that their risk from medical review is limited. Don’t be caught in the comfortable position of believing that everything is okay. Attendees will take away information that will assist in assuring that your hospice truly is prepared for an call for medical review of their charts.



Course Level: Intermediate; 1.2 Accounting CPEs (NASBA/RE) 1 Nursing CNEs contact hours

Learning Outcomes

1. Define the levels of Medical Review that are currently active - UPIC, SMRC, MAC ADR, and RAC.
2. Review how to respond to any level of medical review, including top denials and how to avoid them.
3. Discuss PEPPER reports and other data analysis that agencies need to review.