Home Health & Hospice Week

MAC lists F2F Probe & Educate review topic as active.

Waiting for the therapy goal focus to blow over isn’t a good strategy, considering one MAC’s recent medical review results.

Reminder: HHH Medicare Administrative Contractor Palmetto GBA has added requirements for “Short and/or Long Term Goals Within the Initial (PT/OT/ST as Appropriate) Therapy Evaluation Documentation” via local Local Coverage Determination: Home Health-Physical Therapy (L31542) (see Eli’s HCW, Vol. XXIV, No. 31). Palmetto has used the requirement to downcode and deny millions of dollars in home health agency reimbursement.

In its latest examples, Palmetto reviewed 87 claims with seven HIPPS codes beginning with a “5,” indicating high therapy usage (20 or more visits). It downcoded or denied 29 of the claims, many of them based on the therapy goal requirement. “In the initial physical therapy evaluation, the short term goal(s) and long term goal(s) were not stated in objective, measurable terms, and their expected date of accomplishment,” Palmetto explains in analysis of the results.

The MAC also lists the 11 elements it expects to find in therapy evaluations/reevals (see Eli’s HCW, Vol. XXIV, No. 31 for the elements and related information and advice).

However, due to the low volume and relatively low charge denial rates, Palmetto is discontinuing its reviews of the HIPPS codes starting with “5.”

Latest topics: Palmetto has continued its reviews of HIPPS codes 1BGP (0-13 Therapy Visits, Lowest Scores in the Clinical and Functional Domains and Maximum Score in the Service Domain) and 2CHK (Early Episode, 14-15 Therapy Visits, High Score on Clinical Domain, High Score on Functional Domain), it says on its Active Medical Review webpage updated Dec. 7.

Otherwise, the MAC’s reviews are not HIPPS-code targeted. Instead, they target length of stay and average payment per beneficiary. Palmetto also lists the general “Home Health Services” topic.

Face-to-face: And Medicare’s nationwide Probe & Educate review for Face-To-Face has made its appearance on Palmetto’s list (see Eli’s HCW, Vol. XXIV, No. 42 for more on the P&E review).