Home Health & Hospice Week

One MAC tries harder to educate physicians on home health documentation.

Medicare and its contractors continue to churn out educational materials for home health agencies and others affected by the Pre-Claim Review demonstration project.

Take a look at the latest group of educational offerings from the Centers for Medicare & Medicaid Services and HHH Medicare Administration Contractors:

• MAC Palmetto GBA issued a new Frequently Asked Question set Nov. 14. The FAQs are an accumulation of previously issued information, notes Chicago-based regulatory consultant Rebecca Friedman Zuber. But this gives “reviewers and providers … a common source document that is easy to consult,” Friedman Zuber says. (For a free link to the FAQs, email rebeccaj@eliresearch.com with “Palmetto PCR FAQs” in the subject line.)
• One of PCR’s biggest flaws is “physician unfamiliarity with what is needed for PCR due to poor education from CMS and the MACs,” the National Association for Home Care & Hospice criticizes in its member newsletter. MAC National Government Services looks to be addressing that issue with biweekly live webinars aimed at physicians. “Did you know that CMS requires documentation from the physician medical record to be used as the basis for patient eligibility and that home health agencies are dependent on this documentation for payment?” NGS asks in an email to docs. “We encourage you to sign up for our free educational sessions entitled: ‘Ordering and Certifying Medicare Home Health Services.’” A live question-and-answer session follows each webinar. Physicians and their staff can register for the webinars using the “Education Mega Tab” on the NGS website, the MAC instructs.
• MAC CGS has updated its PCR website, including a new PCR request coversheet and a new link to a question-and-answer set from the MAC’s Sept. 27 Ask-the-Contractor Teleconference on PCR. See the site at www.cgsmedicare.com/hhh/medreview/pre_claim_review_demo.html.
• Palmetto recently offered clarification on PCR-related billing. “Certain Pre-Claim Review (PCR) claims that should not be billed with a Unique Tracking Number (UTN) … [include] A Request for Anticipated Payment (RAP), A Low Utilization Payment Adjustment (LUPA) for four or fewer visits or A Demonstration Claim,” the MAC says. “These claims will Return to the Provider (RTP) with Reason Code 39621 for correction if submitted with a UTN on the claim.”

Do this: “If you have a claim RTP with Reason Code 39621, please be sure to remove the UTN and F9 the claim for processing,” Palmetto instructs.

Tip: “If you are unsure whether you are participating in another demonstration be sure to do a full eligibility check using HIQA,” the MAC adds. “Most demonstrations are only good for one year.”