MAC reviews prompt NAHC to recommend routine internal audits of Hospice providers

Washington, DC ( April 12, 2017

In late March, Medicare Administrative Contractor (MAC) for Home Health and Hospice Palmetto GBA (Jurisdiction JM) announced that it has begun a pre-payment service-specific probe medical review on Hospice claims for Routine Home Care (RHC) Services provided in four locations: patient’s home (Q5001), assisted living facility (Q5002), long-term/non-skilled nursing facility (Q5003), and skilled nursing facility (Q5004). Palmetto is drawing 100 claims from each “location” edit, to review a total of 400 claims.

…Palmetto does note 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.” Completed review results will be posted to the Palmetto GBA website.

While the Palmetto review is relatively modest, previous pre-pay edits for hospice RHC have been focused on long length of stay, so this review represents a departure of sorts from the approach generally taken by the MACs. Further, the hospice industry has been the subject of a growing number of reviews by the Office of the Inspector (OIG), the MACs, and others in recent years. For this reason NAHC reminds all hospices that it is advisable to conduct routine internal audits to ensure that they are closely adhering to eligibility, documentation, and other conditions of payment and participation.

Read the entire original Hospice news article here.

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