Home Health & Hospice Week

Get to know your SMRC.

If you haven’t been targeted by the many ADRs sent by HHH MACs, you likely will be soon.

And it’s not just Medicare Administrative Contractors cracking down on F2F. The Centers for Medicare & Medicaid Services’ newest review contractor, StrategicHealthSolutions, is focusing heavily on HHA F2F in reviewing claims, multiple sources report.

Because Strategic is a Supplemental Medical Review/Specialty Contractor and not a Recovery Audit Contractor, it is not subject to the "pause" RACs are currently under for review activities (see Eli’s HCW, Vol. XXIII, No. 8). CMS gave Strategic the SMRC contract in 2012 (see Eli’s HCW, Vol. XXII, No. 37).

"Strategic is preying on the homecare provider’s greatest vulnerability, that being the F2F requirement," says the Home Care Association of Florida in a recent message to members. "By doing so they are making the same mistakes and contributing to the very same ALJ log jam that the RACs created and that CMS was trying to address with the [RAC] suspension."

HHAs are having success appealing F2F claims at the Administrative Law Judge level, reports Arlene Maxim with A.D. Maxim Consulting in Troy, Mich. But now that the HHS Office of Medicare Hearings and Appeals has announced a two-year — or longer — wait for ALJ hearings, Maxim is "not sure how much help that is," she says.

Note: Find out more about the SMRC at www.strategichs.com/about-smrc/.