Home Health & Hospice Week
Know Your Affirmation From Your Approval Rate
Approval rates are tougher. Under the Review Choice Demonstration, choosing the Pre-Claim Review option is almost always the wisest course of action for achieving reimbursement success, experts agree. But it also makes sense when it comes to qualifying for future review options that are much less burdensome. Under RCD, HHH Medicare Administrative Contractor Palmetto GBA assesses participating agencies every six months. If an HHA achieves a 90 percent or greater PCR affirmation or claim approval rate, it can select either of these less intensive options: Option 4: Selective Post Payment Review – A statistically valid percentage of claims are reviewed every six months based on the total universe of claims submitted within the six-month cycle. Option 5: Spot Check – 5 percent of claims are reviewed after final claim submission and prior to payment. In a Jan. 17 post, Palmetto breaks down the difference between PCR affirmation and claim approval rates. “A claim approval rate is different than the Pre-Claim Review (PCR) affirmation rate,” the MAC explains. “The claim approval rate is for agencies that selected an RCD ADR option (Post-Payment Review, Selective Post-Payment Review, Spot Check). The PCR affirmation rate is for agencies that selected the PCR option.” Difference: “Appeals and partial payments do not count towards your claim approval rate,” Palmetto says. “All initial decisions do apply toward your claim approval rate.” Plus: “The RCD ADR process is different from the [Targeted Probe & Educate medical review] process,” Palmetto adds. For example, “during the RCD ADR review process … the Medical Reviewer does not contact the HHA for missing documents.” There also “are no easily curable telephone calls,” the MAC explains. HHAs under Post-Pay Review must “get their ADR fully paid to count toward the required approval rate,” stresses Joe Osentoski with Gateway Home Health Coding & Consulting in Madison Heights, Michigan. “And this must be on the first submission without any opportunity to add items that a TPE reviewer may afford them.” Bottom line: Those limitations make the claim approval 90 percent “harder to obtain” than the PCR claim affirmation 90 percent, Osentoski says.
Home Health & Hospice Week
- Review Choice Demonstration:
Overwhelming Majority Of Texas HHAs Are Opting For RCD Pre-Claim Review
More than a third of Texas agencies have entered their RCD choice so far. Pre-Claim [...] - Medical Review:
Know Your Affirmation From Your Approval Rate
Approval rates are tougher. Under the Review Choice Demonstration, choosing the Pre-Claim Review option is [...] - Demonstration Projects:
New Year Has Brought New RCD Developments
Here’s how results calculation works. Some Illinois agencies were placed in the wrong review choice [...] - Reimbursement:
iQIES Problems Persist
Keep a record of your failed OASIS submission attempts, NAHC advises. While it’s still too [...] - OASIS:
Change How You Answer M2420 Effective Immediately
Response 2 now applies only to Medicare home health skilled services. Add another OASIS change [...] - Industry Note:
OIG To Eye IRF Discharges To Home Health
Will examination lead to drop in IRF referrals? Another home health-related topic has landed on [...] - Industry Note:
MedPAC Wants Cuts
As expected, the Medicare Payment Advisory Commission has finalized its recommendations to Congress to cut [...] - Industry Note:
Beware This Hospice Billing Trap
Do you know how to bill for a day when a patient changes hospice care [...] - Industry Note:
CMS Quality Conference Is Next Month
If you’d like to join in the Centers for Medicare & Medicaid Services’ quality improvement [...] - Industry Note:
CMS Bungles Some MBIs
Medicare’s conversion to using MBIs rather than HICNs has been pretty smooth, but hasn’t gone [...] - Industry Note:
MAC To Docs: Get Your HH Coding Together
Do you need help getting your referring physicians to provide the documentation necessary for PDGM [...] - Industry Note:
Include IDG Support
Don’t leave out Interdisciplinary Group documentation when you respond to a hospice medical review request. [...] - Industry Note:
Hospice Notifies Families About HIPAA Breach
Instead of electronic files, it’s hard copy paper files that have led Hospice of Anchorage [...] - Industry Note:
Hospice Adds To Name
Another hospice is tweaking its name to indicate its wide array of services. Last fall, [...] - Industry Note:
Hospice Builds Facility
Nonprofit hospice provider Pathways plans to build a 12-patient inpatient hospice facility on its Ft. [...] - Industry Note:
Supervisor Pleads Guilty
A home health supervisor has pleaded guilty to Medicaid fraud in the ongoing Moriarty Consultants [...] - Industry Note:
NPR Criticizes Hospice
Mainstream media is taking another swipe at hospice. “Patients Want To Die At Home, But [...]
