Home Health & Hospice Week

Pointer: Don’t neglect internal audits.

As you update your compliance plan, don’t forget to take into account potential Targeted Probe and Educate claim reviews, Alicia Shickle-Cline, founder of ProCode Compliance Solutions, during AAPC’s HEALTHCON 2024 session, “Deep Dive into Targeted Probe and Educate.”

Consider adding these five TPE-centered actions to your to-do list:

1. Address claims issues before they start with benchmarking and annual internal audits.

2. Put an internal process in place for communicating with your Medicare Administrative Contractor, which includes following the MAC’s required modus of communication (i.e. portal, email, EHR), so that you don’t miss critical requests.

3. Utilize educational opportunities from your MAC to ensure you know billing and regulatory updates.

4. Understand the plethora of risk factors that contribute to items and services being labeled medically unnecessary by the Centers for Medicare & Medicaid Services and your MAC.

5. Follow through on all documentation requests in a timely manner.