Home Health & Hospice Week

Did you land in the minority?

Close to half of home health agencies that Palmetto GBA reviewed under the Probe & Educate Round 2 initiative passed the test, so to speak.

Results: The HHH Medicare Administrative Contractor says it included 1,440 providers in Round 2. "At the conclusion of Round 2, 751 providers were categorized as having Moderate/Major Concerns (2-5 errors) and 689 providers with no or Minor concerns (0-1 error)," a Palmetto spokesperson tells Eli.

In other words, 52 percent of reviewed agencies fell into the Moderate/Major Concerns category, which in the previous round would have sent them on to the next round of Probe & Educate. On the other hand, 48 percent of agencies performed well enough to make it into the Minor Concerns category.

In comparison: MAC CGS reported its Probe & Educate Round 2 results in a different format. CGS denied two-third of the 4,631 claims it reviewed in P&E Round 2, telling Eli that full denials were 54 percent and partial denials 13 percent.

Palmetto is not reporting Probe & Educate results by claim, the Palmetto rep says.

If Palmetto reviewed five claims each from the 1,440 agencies included in the round, the review would have included 7,200 claims. The figure is probably shy of that number in reality, however, experts point out.

Remember: Probe & Educate Round 1 aimed to review five claims from every HHA nationwide. Round 2 excluded agencies in the Minor Concerns category - 15 percent of agencies in Palmetto's case and 5 percent in CGS's, the MACs previously told Eli.

It's not clear just how many of the agencies that "flunked" P&E Round 2 are ending up included in the new Targeted Probe & Educate medical review program.