Home Health & Hospice Week
Intermediary Review Grows, Thanks To New Contractors
If you get a a probe review notice, don't do this. Numerous consultants are seeing more MAC/intermediary probe reviews, which they say may signal that Medicare contractors are ramping up their efforts to detect overpayments before other contractors like ZPICs, PSCs, or RACs get the chance. "It could be that MACs are feeling pressure from the RAC audits" to do more post-payment reviews, which may be a self-preserving effort "to keep their contracts with [the Centers for Medicare & Medicaid Services] in good standing," surmises consultant Sherri Robbins with BKD in Spring-field, Mo. FR&R Healthcare Consulting has also been seeing quite a few probe reviews, reports Betsy Anderson, VP for the firm in Deerfield, Ill. "Some-times it starts out with post-payment reviews, and depending on the percentage of denials, goes into prepay [ones]," says Anderson, who works with nursing homes. Home care providers are seeing similar reviews, sources say. Knowing that intermediaries and contractors may be doing more probe reviews gives you a heads up to sharpen your probe management skills. Hold the 'Mea Culpas' If you get notice of a probe review, don't assume it's because you've done something wrong. You "might look at ... compliance procedures and determine if there was something out of the ordinary going on that might have triggered the probe," suggests Anderson. "Sometimes it could be higher-than-average utilization for a specific service or area," she says. Sometimes it might be claims errors. Be aware of this key difference: When faced with an audit, the provider can sometimes find out why the contractor wants to do the review and explain to the contractor the reason for the utilization difference, Anderson adds. For example, a home health agency may have an intensive post-surgery program that explains higher than usual therapy utilization, industry sources suggest. In some cases, that kind of explanation will suffice to halt the contractor review. "But it's not going to stop the process for a probe," Anderson adds. The contractor will go ahead with the review and make sure the provider has the documentation to support what it has billed to Medicare.
Home Health & Hospice Week
- Reimbursement:
Payment Suspension Proposal Draws Criticism
New anti-fraud regs increase CMS's reach to combat fraud and abuse. A disgruntled employee or [...] - Compliance:
Get Ready For Tougher Enrollment Screening
New regs would charge you for your trouble. Your Medicare payments are poised to come [...] - Fraud & Abuse:
OIG Targets These Home Care Hot Spots For Scrutiny In 2011
HHAs' profit margins, HHRG coding accuracy, and OASIS data will be some of the critical [...] - Medical Review:
Intermediary Review Grows, Thanks To New Contractors
If you get a a probe review notice, don't do this. More medical review from [...] - Audits:
Insufficient Documentation Weakness Among Medicare Providers, Auditors Say
Stay on top of audit requests so you're able to meet all request deadlines. Medical [...] - Industry Notes:
New Anti-Fraud Law Could Delay Your Medicare Payments
Law requires Medicare to use 'predictive modeling' to target claims for pre-pay scrutiny. A provision [...] - Industry Notes:
PECOS Rejections Start In Less Than 3 Months
If you want to get a closer look at the instructions for the PECOS physician [...] - Industry Notes:
HHS Doubles Senior Medicare Patrol Funding
You'll have more sets of eyes examining your claims soon -- and they may not [...] - Industry Notes:
Tap New Secondary Payor Tool
When a patient has no other insurance coverage besides Medicare, you can be sure that [...] - Industry Notes:
New Timely Filing Deadline Hits Dec. 31
You have less than three months to get in your pre-2010 Medicare claims, or risk [...] - Industry Notes:
Reset Your Billing System Password More Often
You'd better brush up on your billing security procedures if NGS/NHIC is your Medicare contractor, [...] - Industry Notes:
RHHI Gives Managed Care Billing Answers
Billing for HHA services to Medicare Advantage-enrolled patients can be a big head-ache. One regional [...] - Industry Notes:
Refer SNFs To New Community Care Brochure
If you'd like to encourage your referring skilled nursing facilities to consider discharge to the [...] - Industry Notes:
HHA Fraudster In Detroit Pleads Guilty
Another participant in a Detroit-area HHA fraud scheme has pleaded guilty. After six of the [...] - Industry Notes:
Hawaii HHA Slapped With Age Discrimination Suit
Lawsuits from employees don't just come in the false claims or wage and hour varieties. [...]
