Home Health & Hospice Week

Florida, Texas hit hardest by new probe edits.

If you’re billing for resource-intensive patients with HIPPS code 2CHL*, be prepared to back up your claims with ironclad documentation.

HHH Medicare Administrative Contractor Palmetto GBA “will be setting four service-specific probe medical review edits for HIPPS code 2CHL*,” the MAC says on its website. “These edits will be set to select 100 claims from each of the following states: Florida and Texas; 100 claims from the following state grouping: Illinois, Louisiana, Mississippi; and 100 claims from all the remaining 11 states within the jurisdiction.”

Background: 2CHL represents early epi-sode claims with 16-17 therapy visits, a high score on the clinical domain, and a high score on the functional domain. The HIPPS code is among those identified as “major risk services” for Palmetto’s re-gion, the MAC says.

Don’t forget: If there isn’t a matching OASIS record in the system for the claim you billed, your claim will be denied, Palmetto notes. And you still need to submit face-to-face encounter documentation, even though the physician narrative is proposed for elimination.