Eli's Hospice Insider
GIP, Long Stays Are Claims Reviewers’ First Targets Post-COVID
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Medical review resumption is proceeding, despite COVID-19 burdens. The three HHH Medicare Administrative Contractors have released information on their medical review topics in light of the Medicare’s program decision to resume medical review this month. Palmetto GBA: Palmetto lists “General Inpatient Care (GIP),” further detailing that involves “Review of inpatient claims for Inpatient Hospice Care greater than or equal to 7 days for Revenue Code 656 and place of service codes Q5004–QA5009.” National Government Services: NGS will review claims with “Length of Stay Over 730 Days (Edit 5ANKP),” according to the MAC’s website. CGS: CGS doesn’t have a hospice topic listed, noting only that it will be “coming soon” on the medical review webpage. “We must receive the medical records necessary to support the billed services within 45 days of the date of the ADR letter,” NGS reminds providers. “Failure to submit the requested documentation in a timely manner may result in denial of the billed service.” Tip: “We recommend you include the original ADR with your response,” Palmetto says in an article about responding to the new postpayment reviews. Get Up To Speed On HOPE Assessment Tool If you want to keep tabs on how the Hospice Outcomes and Patient Evaluation hospice assessment tool is coming along, check out a new report on the tool. The Centers for Medicare & Medicaid Services has posted a 34-page report on the HOPE Technical Expert Panel’s November 2019 meeting. “Measure concepts discussed included pain, dyspnea, caregiver wellbeing, patient preferences, and claims-based measures,” notes the report from HOPE contractor Abt Associates. The Abt team and CMS “will consider TEP feedback towards these measure concepts that emphasize the importance of patient preferences, reducing provider burden, and changes in patient data if changes in condition occur,” says the report at www.cms.gov/files/document/2019hospice-qrptep-summary-reportfinalaugust-2020-002.pdf.
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