Home Health & Hospice Week
MAC Targets Therapy Usage In Medical Review
Wondering what will land you on medical reviewers’ radar screens? If your MAC is Palmetto GBA, now you know.
The Medicare Administrative Contractor lists 13 active medical review topics on its website — one more topic than it reported last quarter. Eleven of the 13 topics feature HIPPS codes indicating either 16-17 therapy visits or 20 or more therapy visits.
Exception: Palmetto lists review for one code, 1BGP*, that indicates only 10 to 13 therapy visits. However, the HIPPS code also indicates the lowest clinical and functional domain scores, according to the MAC.
Palmetto also lists the non-therapy-focused general topic “Aggregate Length of Stay and Dis-bursement/Beneficiary.”
Hospice: Palmetto has dropped one hospice medical review topic since last quarter, leaving only “Hospice Services in SNF,” indicated by code Q5004. The topic Palmetto discontinued was “lengths of stay for all non-cancer diagnoses.”
See the list of active medical reviews at www.palmettogba.com/medicare — click on “J11 MAC Home Health and Hospice” in the left column; choose “General” under the “Medical Re-view” link in the left column; then click on the “Active Medical Reviews” link in the article listing. Or email editor Rebecca Johnson at rebeccaj@eliresearch.com with “Palmetto Active Medical Re-views” in the subject line for a free link to and list of the topics.
Home Health & Hospice Week
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MAC Targets Therapy Usage In Medical Review
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