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Home Health & Hospice Week

Medical Review:

Intermediary Review Grows, Thanks To New Contractors

Published on Wed Sep 08, 2010

If you get a a probe review notice, don't do this. More medical review from ZPICs and RACs may mean more review from your intermediary or MAC too. 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]," [...]
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