Home Health & Hospice Week

After a five-month break from medical review, you may be rusty on the review process.

HHH Medicare Administrative Contractors are offering assistance on how to respond to Additional Development Requests for postpayment review. MACs have not resumed prepayment review yet.

For example: “If you are responding to multiple MR ADR requests, clearly separate the documentation for each claim,” MAC CGS instructs on a new webpage for postpayment reviews. “The use of rubber bands or binder clips, or mailing documentation for each claim in separate envelopes, is recommended. Multiple responses sent together, but not separated, may result in the documentation being imaged as one claim. Do not staple documentation.”

Another example: “When submitting the requested medical record documentation in response to the ADR, please submit point of contact (POC) information for your agency, including name and phone number, for follow up during the review if missing documentation is identified,” MAC Palmetto GBA says on a new article about responding to postpay review.

Plus, “patient identification, date of service and provider of the service should be clearly identified on the submitted documentation,” Palmetto instructs. “We recommend you include the original ADR with your response.”

The CGS postpay review page is at www.cgsmedicare.com/hhh/pubs/news/2020/08/cope18613.html. To access Palmetto’s Aug. 19 postpay review article, go to www.palmettogba.com, select “Jurisdiction M Home Health and Hospice MAC” in the right column, select “Medical Review” from the “Topics” pull-down menu in the top bar, click on “General,” and scroll down to “Latest Articles” links.