Home Health & Hospice Week
MAC Calls Off UPIC Scare
Stay alert to claims hitting S B6001, though. HHH Medicare Administrative Contractor Palmetto GBA is automatically fixing RAPs and claims that “incorrectly suspended” with a reason code indicating review from Unified Program Integrity Control contractor SafeGuard Services, the MAC says. The problem: “Some home health agencies may have had final (end of episode) claims suspended in processing location S B6000 with reason code (RC) 5Z7BS,” Palmetto says on its website. “In addition, Requests for Anticipated Payments (RAPs) may have received line denials with RC 5Z74H. These RCs would normally identify SafeGuard Services (SGS), the Southeastern Unified Program Integrity Contractor UPIC is conducting edits.” The solution: “Palmetto GBA has released all the final claims that incorrectly suspended in processing location S B6000 to allow normal processing,” the MAC says. “RAPs that have finalized with RC 5Z74H will be reprocessed by Palmetto GBA.” Watch for: “HHAs in states within SGS’ jurisdiction may have correctly received these edits,” however, Palmetto warns. “If the claim goes into processing location S B6001, you should comply with the Additional Documentation Request.”
Home Health & Hospice Week
- Fraud & Abuse:
OIG Targets LUPA Gaming In Newest Work Plan Item
Feds will examine cases where one visit translates to additional thousands of dollars. Just where [...] - Compliance:
Take These 4 Steps To Head Off LUPA Troubles
Your PEPPER report could come in handy. With attention on low-visit episodes heating up, now’s [...] - Review Choice Demonstration:
Will Your State Be Next On Pre-Claim Review List?
Medicare to spend nearly $400 million on RCD project, it says. While recently released documents [...] - Medical Review:
Illinois HHAs Hope For Generous Exemptions To RCD
Even agencies that qualify for exemption will be subject to 5% ‘spot check.’ One of [...] - Enforcement:
OIG Racks Up Big Numbers In Latest Period
Nearly $1.5 billion in recoveries keeps the OIG on task. If you’re waiting for federal [...] - Hospice:
Hospice Fraud Settlement Leads To Execs' Salaries Splashed Across The Newspaper
Hospice nursing supervisor admits to hastening patients’ death with overmedication. Two hospice fraud and abuse [...] - Industry Note:
MAC Calls Off UPIC Scare
Stay alert to claims hitting S B6001, though. HHH Medicare Administrative Contractor Palmetto GBA is [...] - Industry Note:
OIG Targets Inappropriate Managed Care Denials
In addition to looking at home health episodes that barely exceed the LUPA threshold, the [...] - Industry Note:
Hospice Access A Problem For Kidney Dialysis Patients
Medicare patients on chronic kidney dialysis have “woefully poor access to hospice care,” says a [...] - Industry Note:
Senior Fraud Patrol Recovers Millions For Medicare
The Senior Medicare Patrol program continues to go strong, with the HHS Office of Inspector [...] - Industry Note:
Medicare To Ease Hospice Billing Next Month
Get ready for changes to your hospice billing July 2. Change #1: “A new hospice [...] - Reader Question:
VA Patient Successfully Sues For Home Care Continuation
The U.S. Department of Veterans Affairs has agreed to continue to provide home care for [...] - Industry Note:
Ohio Nonprofit Affiliate Group Grows
Ohio nonprofit Loving Care Hospice, based in London and Marysville, plans to join Ohio’s Hospice, [...]
