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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