Home Health & Hospice Week
Here's Why TPE Claims Samples Have Been On The Larger Side
Get used to larger claims samples for Targeted Probe and Educate medical review. “Currently contractors utilize the 20 to 40 claim sample as outlined for TPE requirements,” HHH Medicare Administrative Contractor Palmetto GBA says in its Hospice Coalition Questions-and-Answers set from its Feb. 29 meeting, which the MAC posted on May 8. “Utilization, patient census, number of distinct outliers a provider is flagged for are some of the criteria used to identify sample size,” the MAC details in Q&A No. 11. “During initial TPE implementation, Palmetto GBA identified a minimum sample size of 20 for hospices but adjusted to 30 and 40 claims to help reduce the number of audits per provider,” the MAC explains. “As claims are randomly selected, sample sizes are determined prior to the probe and adjusted on an as need basis,” it adds. The Q&As are online at www.palmettogba.com/palmetto/jmhhh.nsf/DID/4184J8QCJK.
Home Health & Hospice Week
- Surveys & Certification:
Expect To See CMPs, Pay Suspensions Handed Down More Often For Condition-Level Deficiencies — Maybe A Lot More Often
Whether it’s called an alternative sanction or an enforcement remedy, it can close agencies’ doors [...] - Compliance:
IDR Process Gets Some Clarifications In New Survey Memo
Here’s what IDR will look like under updated guidelines. Still getting a handle on the [...] - OASIS:
Carve Out Time For OASIS-E1 Training
Even a scaled-back revision requires some planning. Smart home health agencies won’t wait until the [...] - Fraud & Abuse:
Social Media Posts Help Nail Medicaid Home Care Fraudsters
Whistleblowers rake in hundreds of thousands in recent cases. Home health fraud cases aren’t confined [...] - Mergers & Acquisitions:
Catholic Health System, National Home Health & Hospice Chain Join Forces
Plus: Hospice market developments take place from coast to coast. Cincinnati-based Bon Secours Mercy Health [...] - HIPAA:
Follow These 3 Steps To Fulfill Employee Sanction Requirement Under HIPAA
You can’t just look the other way when PHI is at stake. With aggressive cyberattacks [...] - Industry Notes:
Add New Nondiscrimination Final Rule To Your Compliance Checklist
New notices, P&Ps, training are all on the horizon. You may find you have a [...] - Industry Notes:
Oregon HH, Hospice Nurses End Strike
After marching in a picket line while on strike, PeaceHealth home health and hospice nurses [...] - Industry Notes:
Keep Certifying Physician Claims Edit Top Of Mind
The upcoming Medicare claims edit requiring hospice certifying physicians to be enrolled or validly opted [...] - Industry Notes:
FDA Program Aims To Boost Health Care In The Home
Another federal agency is getting behind the idea of moving more health care into the [...] - Industry Notes:
Here's Why TPE Claims Samples Have Been On The Larger Side
Get used to larger claims samples for Targeted Probe and Educate medical review. “Currently contractors [...]
