Home Health & Hospice Week

Industry Note:

MAC Launches Hospice RHC Probe In All Settings

One MAC is turning up the heat on hospice claims.

HHH Medicare Administrative Contractor Palmetto GBA has announced a probe audit of hospice claims with Routine Home Care services. It doesn’t matter whether the services are furnished at home, in an ALF, nursing home, or SNF —they will trigger the audit.

“This probe is based on data analysis which included identified CERT errors, internal analysis and prioritization, as well as past experience, which identified Routine Home Care Hospice Services as a major risk,” Palmetto says. “Probe edits will be set and will select a sample of 100 claims from each edit.”

Among the many items Palmetto lists as required in responding to an ADR for this probe is “for dates of service that include the third benefit period or later … the face to face encounter document.” If reviewers find “significant billing aberrancies,” provider-specific medical review and/or one-on-one education may follow, Palmetto warns.

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