Home Health & Hospice Week

Brace for more medical review.

Home health agencies can expect medical review heat to get turned up to high, now that one Recovery Audit Contractor has a new home health topic approved for review.

Region 5 RAC Performant will "begin home health complex review for documentation and medical necessity," says HHH Medicare Administrative Contractor CGS on its website.

The complex review will apply to "all HHA MACs except for the following demonstration states: Delaware, District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia," Performant says on its website.

What the RAC means by "demonstration states" is unclear, notes the National Association for Home Care & Hospice in its member newsletter.

Claims having a "claim paid date" more than three years prior to the ADR date will be excluded, NAHC says.

Performant posted the topic approved by the Centers for Medicare & Medicaid Services on Jan. 10, 2018, according to the RAC's website at https://performantrac.com/audit-regions/region-5.

CMS named Performant as the home health, hospice and DME RAC in 2016 (see Eli's HCW, Vol. XXV, No. 41).

HHH MACs also have named medical necessity as a topic they are pursuing under Targeted Probe & Educate medical review (see Eli's HCW, Vol. XXVII, No. 2).