Hospice Consulting Services

We work with industry professionals and organizations to help gain acceptance for hospice in health care, and ensure hospice care is available to all eligible patients who want hospice care. Click on the tabs below to learn more about the specific services we offer.


Regulatory Support

Regulatory Support

Managing regulatory compliance at your hospice under increasing government scrutiny requires a combination of knowledge of regulations and real-time experience with hospice of all sizes. Roseanne Berry and Charlene Ross have:

  • Opened over 20 startups in 9 states which were deficiency-free in the initial phase of oversight.
  • Implemented internal “no deficiencies” standards resulting in significant improvement in internal clinical survey scores.
  • Developed mock survey tools matching Medicare COPs and other regulatory requirements to ensure programs were survey ready.
  • Successfully managed fast-track and slow-track Medicare terminations.
  • Roseanne Berry has been an active member of the NHPCO Regulatory Committee.

R&C Healthcare Solutions can work with your hospice to support and improve your regulatory compliance through:

  • Survey preparation.
  • Medicare and state-specific mock surveys and risk assessments.
  • Development of plans of correction for regulatory – Medicare and state – surveys.
  • Coordination and oversight of Medicare or state plan of correction, 23-day turnarounds, fast-track and slow-track terminations.
  • Survey response team for regulatory challenges.
  • Conduct probe and discovery audits.
  • Medical review audits.
  • Ongoing telephonic support for hospices related to regulatory questions.
Compliance Programs

Compliance Programs

Through their extensive hospice experiences, the founders of R&C Healthcare Solutions have in-depth experience with compliance programs. At the core of compliance are complex rules and regulations that effect hospice organizations on a corporate, multi-site or single-provider level.

As part of their hospice experiences, Roseanne Berry and Charlene Ross:

  • Mitigated complex risks for a multi-state organization.
  • As a Chief Compliance Officer, Roseanne Berry led the development and management of a company-wide compliance program that met OIG guidance.

R&C Healthcare Solutions are experts at compliance and can support your compliance program with:

  • Development and implementation of a robust corporate compliance plan.
  • Annual review of corporate compliance program.
  • Monitoring a Corporate Integrity Agreement.
  • Compliance score card/risk assessment.
  • Risk management services.
Medical Review Management

Medical Review Management

Medicare contractors (generally FI/MAC) perform data analysis of claim data to identify atypical billing and verify if billing problems exist through probe reviews. Hospices may be selected for medical review when atypical billing patterns are identified, or when a particular kind of problem, such as a high percentage of long length of stay patients, is identified.

During their years of experience in hospice, Roseanne Berry and Charlene Ross amassed volumes of medical review experience:

  • Processed on average nearly 1000 medical review requests annually with low denial rates at all levels of the process.
  • Developed tools to manage eligibility audits.
  • Proactively performed random eligibility and length of stay audits.
  • Roseanne Berry has been an active member of Palmetto GBA Hospice Coalition (FI/MAC) which serves as the provider’s liaison to the fiscal intermediary.

R&C Healthcare Solutions can improve your ability to prepare for and manage medical review by:

  • Evaluating process for managing ADRs from receipt through release.
  • Implementing a process for tracking and discovering pending ADRs.
  • Reviewing clinical records for completeness prior to sending to intermediary (RHHI/MAC).
  • Managing and coordinating redeterminations, reconsiderations and administrative law judge hearings.
  • Managing both prepayment and post-payment reviews.
  • Educating on eligibility and medical review processes.
  • Auditing:
    • Eligibility.
    • Length of stay.
    • General inpatient.
    • Continuous care.
    • Others as needed.
Aggregate Cap Management

Aggregate Cap Management

Cap management is essential for all hospices. Managing Cap is challenging, requires diligence in monitoring and should be part of a hospice’s overall strategic and marketing plan. Working for VistaCare at the forefront of Cap related issues, Roseanne Berry and Charlene Ross gained a wealth of knowledge in the seriousness of proper Cap management, what causes Cap, the challenges and complications of managing it, and finally, how to reduce it.

  • Roseanne Berry and Charlene Ross worked to reduce Cap by 50% overall with complete elimination in some programs.

R&C Healthcare Solutions can help improve your Cap exposure with:

  • Cap education.
  • Tools and processes to track Cap liability.
  • Strategies to minimize Cap into a hospice marketing plan.
  • Analysis of current patient population.
Staff Development, Education and Workshops

Staff Development, Education and Workshops

Ongoing education and training are crucial to a successful hospice. New topics and refresher courses alike keep staff up-to-date on critical topics such as compliance and patient care, while also providing growth opportunities for their careers in hospice.

Both national and state speakers, Roseanne Berry and Charlene Ross bring insight to their presentations that only come with years of hands-on hospice experience.

Visit the Presentations and Publications page to review their presentation history.

Whether your organization requires a 2-hour in-service or a long-term training program, R&C Healthcare Solutions can meet your educational needs and improve the performance of your hospice training your teams on the following topics:

  • Medicare Conditions of Participation.
  • Eligibility.
  • Quality Assessment and Performance Improvement (QAPI).
  • Performance Improvement Projects (PIPs).
  • Levels of care.
  • Referral to admission process.
  • Medical review process.
  • Hospice care in the nursing home.
  • Documentation principles.
  • Medicare regulations.
  • Survey readiness.
  • Live discharges.
  • Effective interdisciplinary group care planning meetings.
  • Coordination of care.
  • Pain assessment and management.
  • Comprehensive assessment.
  • And more…
Quality Assessment and Performance Improvement (QAPI)

Quality Assessment and Performance Improvement (QAPI)

The QAPI condition of participation provides the most overarching and greatest impact on a hospice’s current operations. R&C Healthcare Solutions has the experience to assist hospices in all aspect of quality assessment and performance improvement.

  • Roseanne Berry served on the NHPCO Quality Advisory Council which developed the Quality Partners Initiative.
  • Charlene Ross:
    • Participated in NHPCO QAPI collaboratives as well as the CMS sponsored PEACE project which identified quality indicators for hospice benchmarking.
    • Designed, standardized and computerized CQI at a large multisite hospice organization then transitioned the program to a QAPI model.
    • Reduced FTEs on-call and improved patient family satisfaction scores through performance improvement projects.

We can work alongside hospice staff in the following ways:

  • Leading a Process Improvement Project (PIP).
  • Reviewing a QAPI program.
  • Writing QAPI plans.
  • Integrating patient care data into the overall QAPI plan.
  • Implementation of a QAPI model that meets the Medicare CoP requirements.
  • Using family satisfaction scores to drive performance improvement initiatives.
  • Serve as coaches for collaborative/process improvement initiatives to keep the project on track.
  • Provide an assessment of current data collected and help identify the high volume, problem prone and high risk areas.
Operational Support and Improvement

Operational Support and Improvement

Hospice operations are critical to the success of a hospice. To succeed in today’s environment of cost increases and reimbursement constraints, a hospice must operate in a cost-efficient and effective manner while assuring exceptional end-of-life care.

As a senior leader in a hospice organization, Charlene Ross successfully:

  • Partnered with patient care vendors to maintain high-quality products and services while significantly reducing costs.
  • Updated staffing guidelines for homecare and inpatient units (IPUs).
  • Developed and updated clinical standards and financial benchmarks for homecare and IPUs.
  • Redesigned the certification process.
  • Created process improvements that resulted in a significant reduction in lost billing days and the elimination of compliance risk.
  • Developed tools to track timely certifications.

Roseanne Berry Initiated an occupational safety and loss prevention program with 47% reduction in total costs in one year.

Charlene Ross and Roseanne Berry championed the adoption of the Open Access philosophy to successfully admit all eligible hospice patients regardless of the complexity of their care needs while maintaining fiscal responsibility.

Below are samples of ways R&C Healthcare Solutions can assist your operations:

  • Review all aspects of costs associated with the organization.
  • Establish benchmarks for patient care and administrative costs.
  • Establish medical supplies formulary.
  • Discover and implement in-patient unit efficiencies.
  • Determine staffing ratios and develop guidelines.
  • Prepare for accreditation.
  • Implement process improvements.
Policy, Procedure and Form Development

Policy, Procedure and Form Development

One powerful way to improve operational efficiency and manage regulatory compliance is through effective policy, procedure and form development. Streamlining policies and procedures to ensure they are regulatory compliant and developing forms to meet policy and procedure standards is one of R&C Healthcare Solutions’s specialties. Working with hospices of all sizes R&C Healthcare Solutions has:

  • Created policy and procedure manuals covering regulatory requirements in over 14 states.
  • Maintained and updated policy and procedure manuals to meet ever-changing state and federal regulations.
  • Created clinical documentation forms in line with policies and procedures that identified patient needs, met regulatory requirements and promoted high-quality and regulatory compliant patient care.

R&C Healthcare Solutions can strengthen your policies, procedures and forms are through:

  • Revision of the existing policy manual to be compliant with changes in regulatory standards and Medicare CoPs :
    • Compliant with CHAPs.
    • Compliant with The Joint Commission.
Key Performance Indicators (KPI) and Dashboard Development

Key Performance Indicators (KPI) and Dashboard Development

Identification of KPIs provides valuable insight into operational issues allowing a hospice improve its operations. Clinical expertise and an understanding of hospice financials are required for accurate KPI development. R&C Healthcare Solutions has used their experience in the past to:

  • Redefine KPIs. .
  • Integrate financial and clinical KPIs to provide overall hospice KPIs that demonstrate the interrelatedness of all KPIs.
  • Identify KPIs in financial and clinical data for electronic dashboarding solutions with capabilities to drill down into indicator details to identify areas impacting performance.
  • Utilize KPIs to analyze, identify and solve operational issues.

R&C Healthcare Solutions can assist a hospice to build a key indicator dashboard specific to its needs by:

  • Identifying key indicators that drive your business and allow you to successfully manage your hospice.
  • Utilizing QAPI to design and identify key indicators and success measurements for a hospice.
  • Implementation of a QAPI model that meets Medicare CoP requirements.
  • Using family satisfaction scores to drive performance improvement initiatives.
  • Serving as coaches for collaborative and performance improvement initiatives.
  • Integrating the CMS data requirements into the dashboard.
Acquisition, Turn-Around and Start-Up Support

Acquisition, Turn-Around and Start-Up Support

Entering new markets, whether by acquisition or start-up, involves planning and risk management.

The partners of R&C Healthcare Solutions have experience from the perspective of the company performing the acquisition and from the company being acquired. Both situations require experience and skill for the transition to be successful and R&C Healthcare Solutions has both:

  • Led and performed due diligence, acquisition and integration of over 40 programs.
  • Provided documentation, validation for processes and other critical business operational information to acquisition prospects and provided staff support during acquisitions creating positive and smooth transitions.
  • Managed turn-around initiatives for struggling programs by assessing their status, putting action plans in place, developing efficiencies, building leadership and fostering growth to move programs towards profitability.
  • Opened over 20 programs and inpatient units/facilities from concept, to regulatory licensure, to profitability.

If you are in the process of an acquisition, contact R&C Healthcare Solutions to assist with:

  • Due diligence (clinical and operational key functions).
  • Due diligence regulatory compliance.
  • Due diligence in the cost of patient care:
    • Analysis.
    • Benchmark development.
    • Control plans.
    • Staffing review and models.
    • Pharmacy review and formulary implementation and management.
    • Medical supply review and management.
    • Post-acquisition integration support. Change agents.


Ready to get started? Contact us.