Palmetto Announces Probe Medical Review on Hospice Claims for RHC Services

Posted on Thursday, April 13, 2017 7:14 PM

Medicare Administrative Contractor (MAC) for Home Health and Hospice Palmetto GBA (Jurisdiction JM) announced the implementation of a pre-payment service-specific probe medical review on Hospice claims for Routine Home Care (RHC) Services.

The probe review of routine home care will be provided in the following locations:
• Patient’s home (Q5001)
• Assisted living facility (Q5002)
• Long-term/non-skilled nursing facility (Q5003)
• Skilled nursing facility (Q5004)

Palmetto will draw 100 claims from each “location” edit, to review a total of 400 claims.

Palmetto’s announcement explains that the “probe is based on data analysis which included identified CERT errors, internal analysis and prioritization, as well as past experience, which identified RHC Services as a major risk.”

From NAHC’s understanding, there’s no total upper limit of claims from a single provider that would be subject to review.

However, Palmetto states that, “[i]f significant billing aberrancies are identified, provider-specific medical review may be initiated, and individual providers with significant denials may be contacted for one-on-one education.”

The completed results will be posted to the Palmetto GBA website.

NAHC also wants to remind all hospices to conduct routine internal audits to ensure they’re obeying eligibility, documentation and other conditions of payment and participation.

Click here for more information regarding the Palmetto probe and requirements related to Additional Documentation Requests (ADRs).

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