Two New NGS Pre-Pay Probes Have Been Announced for Hospice Agencies

Posted on Thursday, July 27, 2017 5:31 PM

Two new NGS pre-pay probes were announced on July 10th. This affects hospice agencies in CT, MA, ME, NH, RI and VT.

MPP Edit #5A121 is a service-specific probe for hospice services provided to beneficiaries with non-cancer diagnosis(es) and LOS greater than 180 days. This is to ensure that the documentation and criteria requirements are met and that the hospice services are medically reasonable and necessary.

MPP Edit #5A124 is for hospice general inpatient care.

Both medical review edits are prepayment edits. Providers should ensure that documentation in the patient’s medical record supports the GIP level of care, or continued eligibility after 180 days. NGS reports that the edits were turned on Tuesday July 18th and that providers should begin receiving ADRs shortly.

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Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!

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