Eli's Hospice Insider

Use a new resource to make sure you don’t waste TPE education call.

The same turnaround deadline for Targeted Probe and Educate decisions which will get you quick determinations is also making it hard for providers to support their claims. And providers shouldn’t expect a break on that any time soon, indicates a new question-and-answer set posted by HHH Medicare Administrative Contractor Palmetto GBA.

Question: “We are getting calls when there is missing documentation. It is usually something from the physician, or something not necessarily found in our … medical records,” a provider asked Palmetto in its March 4 TPE Hot Topic teleconference. “Has there been any consideration for a longer period of time than three days to get the information back to the reviewer? If we have to reach out [to] the physician, it’s difficult to get confirmation within three days.”

Answer: “The Centers for Medicare & Medicaid Services (CMS) requires medical reviews to be completed within 30 days of the receipt of medical records,” Palmetto explains. “In order to meet that requirement we must receive any requested information for a particular review within that 30 day timeframe. In that short turnaround time we may only have three days to allow for a response. We do try to request needed information early in the review process to allow adequate response time,” the MAC adds.

Meanwhile, MAC CGS has developed a new tool to help hospices prepare for their post-TPE probe education call. The tool “provides a check list of items to prepare before the call, and what actions you may need to take after the call,” CGS says on its website. The tool also describes how the call will work.

For example: “During the call, the educator will begin with the denial reason for which the most claims are denied. They will state the beneficiary’s name and the dates of service for the claim, the beneficiary’s remarks and discuss specific findings related to the documentation submitted,” the tool notes.

Note: See the 13 other Q&As in Palmetto’s set at https://palmettogba.com/palmetto/providers.nsf/docsCat/Providers~JM Part A~Medical Review — click on the “Targeted Probe and Educate” link, then choose the March 27 article from the article list. The CGS tool is at https://cgsmedicare.com/hhh/education/materials/pdf/tpe_post_probe_tool.pdf.