Home Health & Hospice Week
Bene-Sharing Medical Review Topic Will Examine Outliers
Watch out for what patients do behind your back. If you’re curious about Palmetto GBA’s new medical review topic, take a look at some details the MAC has shared with Eli. On Aug. 21, Palmetto listed “Bene Sharing” as a new medical review topic, a spokesperson for the HHH Medicare Administrative Contractor confirms. “Beneficiary sharing is a new Palmetto GBA focus for Targeted Probe and Educate (TPE) probe review as part of our Improper Payment Reduction Strategy,” he explains. Initial notification letters to providers selected for the new edit began on Aug. 23. Exception: “The Review Choice Demon-stration for Home Health Services providers located in the states of Illinois and Ohio are not subject to this TPE probe review,” the MAC says. Just what will land a home health agency on TPE for this topic? “Providers selected for the beneficiary sharing edit were identified as outliers for number of beneficiaries receiving similar/same services from different Home Health providers over a period of time,” according to the MAC spokesperson. Remember, MACs select providers for TPE probe review “if data analysis indicates there are billing practices that vary from their peers.” Documentation submitted in response the probe should support the patient’s eligibility and the medical necessity of the services.
Home Health & Hospice Week
- Audits:
OIG Slaps HHA With $1.26 Million Overpayment
Feds’ extrapolation practices are ‘flawed and unreliable,’ agency counsel blasts. Backtracking on a big portion [...] - Hospice:
Prepare To Make These Election Statement Changes Next Year
Consider the statement step 1 in a new 2-part election process. You have extra time [...] - Elections:
Medicare Presses Ahead With Burdensome Addendum
You’ll have to wade into the messy gray area of what’s unrelated. The optional second [...] - Regulations:
Here's What Medicare Expects To See In Your New Election Statement Addendum
You’ll need to become an expert on what’s related — and what’s not. Get ready [...] - Emergency Preparedness:
Dorian Tests Emergency Preparedness
Public health emergencies declared in 3 states and Puerto Rico so far. At press time, [...] - Industry Note:
Bene-Sharing Medical Review Topic Will Examine Outliers
Watch out for what patients do behind your back. If you’re curious about Palmetto GBA’s [...] - Industry Note:
Don't Overlook This Important Consideration When Scoring GG0130E
Clinicians continue to struggle with completing the new GG OASIS questions. For example: “For GG0130E [...] - Industry Note:
Having Trouble Keeping Your HHCCNs, ABNs, And NOMNCs Straight? Turn To This New Resource
If you have questions about Medicare beneficiary notices that no amount of research seems to [...] - Industry Note:
CMS Sends MACs The Final Hospice Numbers In New Transmittal
The hospice rates and other payment changes taking effect next month have been officially communicated [...] - Industry Note:
There's An App For That — Learn About Blue Button 2.0 And The 'Data At The Point of Care' Pilot In CMS' Latest Podcast
The Centers for Medicare & Medicare Services’ latest podcast takes on the topic of electronic [...]
