Home Health & Hospice Week

• Therapy. "One of the easiest targets for the RAC audits would be therapy, since it has a direct measurable impact on payment," predicts consultant M. Aaron Little with BKD in Springfield, Mo.

For example: Just one denied therapy visit can cost you $600 if you go from six to five visits.

• High reimbursement outliers. "RACs will likely look first at ... providers outside the norm,"expects consultant Tom Boyd with Rohnert Park, Calif.-based Boyd & Nicholas. For instance, an HHA with an average payment of $4,500 per episode when its neighbors typically see $3,000 will raise red flags, Boyd tells Eli.

• High utilization outliers. It won't just be dollars that attract RACs' attention, Boyd adds. Volume indicators, such as an agency that averages two-and-a-half recerts when local peers see just one-and-a-half,could wind up in RACs' crosshairs.

• Long-stay patients. Hospices have been hit hard with allegations that they are admitting patients too early. Expect reviewers to zero in on long-stay hospice patients to examine their eligibility for the benefit,industry veterans say.