Home Health & Hospice Week

Getting put on medical review for your Medicare Advantage claims won’t get you out of regular Medicare review, and vice versa, a recent question-and-answer set on the Targeted Probe and Educate medical review program shows.

“Palmetto GBA does exclude Medicare Secondary Payer (MSP) claims from the edit sample, but a MA Plan is not a primary payer over Medicare,” the MAC explains in a recently posted Q&A set from a June 3 teleconference on TPE. “You would not submit a claim to traditional Medicare for a patient in a MA Plan; therefore, it would not be edited. There is no relationship between any MA Plan and Palmetto GBA or any Medicare contractor where we exclude review based upon the other entity reviewing.”