Home Health & Hospice Week

Comparative Billing Reports coming out.

Exactly which home health agencies and claims will be subject to TPE is still unclear, but one MAC has identified the first batch of hospice claims that will go under the review microscope.

The Centers for Medicare & Medicaid Services recently instructed all Medicare Administrative Contractors to switch their regular medical review activities over to the TPE model (see story, p. 282). HHH MAC CGS says it “will initiate probe and educate reviews to address hospice length of stays greater than 240 days and greater than 730 days with non-cancer related diagnoses,” according to a recent article.

“The reviews will involve identifying providers through data analysis who submit an increased number of claims for length of stay greater than 240 days and greater than 730 days with noncancer related diagnoses,” CGS explains. As with the TPE process already announced for HHAs, MACs will ID 20 to 40 “outlier” claims per provider “through data analysis.”

In conjunction with the TPE focus, CGS is providing a Comparative Billing Report on non-cancerous diagnoses and length of stay. The CBR, which contains data and information from Sept. 1, 2016, to May 31, 2017, “allows providers to be preemptive in their approach to hospice compliance and Medicare guidelines,” CGS says.

See the CBR benchmarks broken out by region, as well as more information on responding to ADRs, at www.cgsmedicare.com/hhh/pubs/news/2017/0917/cope4502.html.