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Home Health & Hospice Week

Industry Notes:

CMS Adds One More Medical Review Burden

Published on Wed Nov 16, 2011

Your utilization may land you in new medical review crosshairs. You may receive even more medical review requests, thanks to a new CERT project. "To help reduce the Comprehensive Error Rate Testing (CERT) program error rates, Palmetto GBA was recently funded by CMS to undertake additional medical review projects that involve medical review of and education for certain ... claims that contributed to the majority of the J11 MAC CERT payment errors," Palmetto says on its website. That includes home health claims. "Providers selected for education and/or medical review are selected based on the frequency of their billings" for the relevant services, the MAC says. "Palmetto GBA's educational and review efforts will primarily focus on reducing payment errors from insufficient documentation and improper coding. Providers will receive written results of the project's findings if being selected for medical review." Right now the project is focusing on prepayment review, but could [...]
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