Home Health & Hospice Week

One contractor reduces audit scope to provide relief.

You may not feel like medical reviewers are taking it easy on your hospice, but it could actually be worse.

So shows a new question-and-answer from HHH Medicare Administrative Contractor Palmetto GBA’s Oct. 13 Hospice Coalition meeting.

Question: “We appreciate Palmetto GBA requesting only 20 records during [Targeted Probe and Educate] Medical Review when the sample size can be up to 40 claims,” says one hospice, according to the newly posted Q&A. “Please know that hospices continue to experience significant staffing shortages, even to the point of Quality and Compliance staff having to return to making visits to home patients to ensure patient needs are met. It is a significant burden for organizations to be under medical review, and even more so during these unprec­edented times. In addition to TPE audits, we are seeing audits from other contractors such as the SMRC and UPIC. Will Palmetto please continue to request only 20 claims per sample unless there is a significant problem identified during that sample that indicates a need for a larger sample?”

Answer: “Palmetto GBA will adjust the sample sizes to account for the error rate within our jurisdiction. We will continue with an approach of 20–40 claims as outlined by [the Centers for Medicare & Medicaid Services] for TPE,” the MAC answers. “In order to help providers, Palmetto GBA has reduced the scope of the number of audits running for Hospice providers,” it adds.

Note: The 12-Q&A set is at www.palmettogba.com/palmetto/jmhhh.nsf/DID/TJAN11GP5Y.