Eli's Hospice Insider
Surprise: Targeted Probe & Educate Applies To You, Too
Long-stay claims first under the TPE microscope. If you thought you were dodging a medical review bullet because you aren't one of the provider types subject to the Probe & Educate campaign, think again. The Centers for Medicare & Medicaid Services recently instructed all Medicare Administrative Contractors to switch their regular medical review activities over to the TPE model. HHH MAC CGS is wasting no time applying TPE to hospices. CGS says it "will initiate probe and educate reviews to address hospice length of stays greater than 240 days and greater than 730 days with non-cancer related diagnoses," according to a recent article. "The reviews will involve identifying providers through data analysis who submit an increased number of claims for length of stay greater than 240 days and greater than 730 days with noncancer related diagnoses," CGS explains. As with the TPE process already announced for home health agencies, MACs will ID 20 to 40 "outlier" claims per provider "through data analysis." In conjunction with the TPE focus, CGS is providing a Comparative Billing Report on non-cancerous diagnoses and length of stay. The CBR, which contains data and information from Sept. 1, 2016, to May 31, 2017, "allows providers to be preemptive in their approach to hospice compliance and Medicare guidelines," CGS says. See the CBR benchmarks broken out by region, as wellas more information on responding to ADRs, at www.cgsmedicare.com/hhh/pubs/news/2017/0917/cope4502.html.
Eli's Hospice Insider
- Reimbursement:
Consider Whether You Should Seek RHC, SIA Payment Adjustments
It's up to you to seek your rightful reimbursement for payment errors under reform. The [...] - Billing:
Follow These Dos And Don'ts For Hospice Reform Payment Corrections
Including transfer patients or patients' PHI are both no-nos. The new easier method to submit [...] - Payment:
You Can't Submit NOEs Electronically Without This Crucial Item
Take a look at the NOE submission requirements in the recently released NOE companion guide. [...] - Medical Review:
Surprise: Targeted Probe & Educate Applies To You, Too
Long-stay claims first under the TPE microscope. If you thought you were dodging a medical [...] - Studies & Surveys:
Hospice Use Saves Money, According To Recent Studies
Are you doing enough to address caregivers' problems? End-of-life spending, obese patients' access to hospice, [...] - Hospice Notes:
Live Discharge Rate Attention Dogs Hospices
News outlets focus on possible gaming. The hospice industry's ratio of live discharges is actually [...] - Hospice Notes:
Ace Sequential Billing Requirements For Billing Success
Failing to follow sequential billing rules for hospice is not only cash flow-draining, it's also [...] - Hospice Notes:
Preview Error Won't Show On November Hospice Compare Refresh
If your Hospice Compare preview report for the next refresh looks a little weird, it [...] - Hospice Notes:
Share Your Medicare Improvement Ideas Before Thanksgiving
The change in presidential administrations may give you a chance to offer big-picture suggestions to [...] - Hospice Notes:
Medicare Termination Notices Hit Cyberspace
The Centers for Medicare & Medicaid Services has started publishing termination notices on its website. [...] - Hospice Notes:
Unraveling Of San Diego Hospice Legacy Continues
San Diego-based Scripps Health, the health system that bought high-profile San Diego Hospice's cliff-top inpatient [...] - Hospice Notes:
Medicare Ramps Up Beneficiary Card Transition
Medicare won't start sending out its new beneficiary cards until next April, but it's already [...] - Hospice Notes:
Seniors Continue To Patrol For Medicare Fraud
Don't be surprised if you get some pointed billing questions from your patients. The HHS [...]
