Eli's Hospice Insider
MAC Medical Reviewers Target Long Stays, GIP In Newly Announced Topics
Just because CGS is the last HHH MAC to announce hospice topics, doesn’t mean it will be the easiest on agencies. One HHH Medicare Administrative Contractor has finally landed on the hospice medical review topics it wants to pursue, now that review is back in effect. Reminder: In August, the three HHH MACs released their topics as the Centers for Medicare & Medicaid Services announced the resumption of medical review, but CGS didn’t pinpoint hospice targets at that time (see HCW by AAPC, Vol. XXIX, No. 32). Now, CGS has listed two hospice topics for post-payment review, and they are both related to longer-than-average stays. But they also both steer away from claims under COVID-19. No. 1: Length of stay 730+ days (reason code 5M000): “This review selects any hospice claim with a length of stay (LOS) 730+ days excluding diagnosis codes between C00 and D49.9 submitted with dates of service prior to March 1, 2020,” CGS says. No. 2: General Inpatient care ? 7 days (reason code 5M001): “This review selects any hospice claim with revenue code 0656 greater than or equal to 7 days submitted with dates of service prior to March 1, 2020,” CGS explains. CMS has not yet approved any topics for prepayment review. See the list of all CGS home health and hospice medical review topics at www.cgsmedicare.com/hhh/medreview/activitylog.html — current topics are marked “active” in the status column. 
Eli's Hospice Insider
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