Home Health & Hospice Week

Industry Note:

MAC Launches Pre-Pay Audit Of BG HIPPS Code Claims

Home health agencies in 13 states are about to have 100 claims reviewed in a prepayment audit by Palmetto GBA. Palmetto “will be performing pre-payment service-specific probe medical review on Home Health claims, utilizing the BG** HIPPS Codes, Early or Late Episodes,” the Medicare Administrative Contractor says in a new website post. “This probe is based on internal data analysis which included prioritization of the HIPPS Codes and will be focused on OASIS validation.”

The codes indicate a low clinical domain and moderate functional domain. Edits will cover Alabama, Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee and “will select a sample of 100 claims for each edit,” the MAC adds.

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