Eli's Hospice Insider
Hospices Besieged With ADRs
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You're not alone if you feel like you're getting bombarded with additional development requests from your home health and hospice Medicare Administrative Contractor. "We have been hit hard with them," one Illinois home care representative said in a recent Ask the Contractor Teleconference (ACT) for HHH MAC
"Is there a cap in terms of the number of claims selected in an initial probe?" asked another agency in the teleconference. "I am just wondering how many more we should be expecting."
Palmetto "is conducting probe reviews on both home health and hospice services," the MAC said, according to its transcript of the ACT. "These reviews are in an effort to prevent inappropriate payments," it added.
If you're on the ADR list, you may not be out of the woods yet. "Typically a service-specific probe sample is 100 and a provider-specific probe sample is 20 to 40," Palmetto explained.
Plus:
The Comprehensive Error Rate Testing (CERT) project "is currently sampling five per code, for hospice it is 25 claims and for home health it is 35 claims," Palmetto added."Every effort will be made to move providers through the process as quickly as possible," Palmetto promised in the ACT.
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