Home Health & Hospice Week

Home care providers hoping to see relief on submission timelines under Targeted Probe and Educate medical review are out of luck, indicates a new question-and-answer set posted by HHH Medicare Administrative Contractor Palmetto GBA.

Question: “We are getting calls when there is missing documentation. It is usually something from the physician, or something not necessarily found in our … medical records,” a provider asked Palmetto in its March 4 TPE Hot Topic teleconference. “Has there been any consideration for a longer period of time than three days to get the information back to the reviewer? If we have to reach out [to] the physician, it’s difficult to get confirmation within three days.”

Answer: “The Centers for Medicare & Medicaid Services (CMS) requires medical reviews to be completed within 30 days of the receipt of medical records,” Palmetto explains. “In order to meet that requirement we must receive any requested information for a particular review within that 30 day timeframe. In that short turnaround time we may only have three days to allow for a response. We do try to request needed information early in the review process to allow adequate response time,” the MAC adds.

See the 13 other Q&As in the set at https://palmettogba.com/palmetto/providers.nsf/docsCat/Providers~JM Part A~Medical Review — click on the “Targeted Probe and Educate” link, then choose the March 27 article from the article list.