Home Health & Hospice Week
Get Ready For Serious Scrutiny Of Your HIPPS Claims
Palmetto set to launch medical review edits for high-denial rate codes.
Your claims for certain Home Health Insurance Prospective Payment System codes are under review, according to a recent Palmetto GBA announcement. The Jurisdiction 11 A/B Medicare Administrative Contractor’s medical review department will conduct a service-specific prepay complex review on claims billed for the top 20 Home Health HIPPS codes.
Palmetto plans to set service-specific complex targeted medical review edits for the two HIPPS codes found to have the highest claim count denial rates. The edits will apply to four regions within the J11 home health and hospice jurisdiction: Midwest (IL, IN, OH); Southeast (KY, NC, SC, TN); Southwest (AR, LA, NM, OK, TX); and Gulf Coast (AL, FL, GA, MS).
When finalized, the MAC may pay in full or in part or deny the claim. If you receive an Additional Documentation Request, you must submit the requested medical record information to Palmetto within 30 days.
Home Health & Hospice Week
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