Eli's Hospice Insider
Surprise: Targeted Probe & Educate Applies To You, Too
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Long-stay claims first under the TPE microscope. If you thought you were dodging a medical review bullet because you aren't one of the provider types subject to the Probe & Educate campaign, think again. The Centers for Medicare & Medicaid Services recently instructed all Medicare Administrative Contractors to switch their regular medical review activities over to the TPE model. HHH MAC CGS is wasting no time applying TPE to hospices. CGS says it "will initiate probe and educate reviews to address hospice length of stays greater than 240 days and greater than 730 days with non-cancer related diagnoses," according to a recent article. "The reviews will involve identifying providers through data analysis who submit an increased number of claims for length of stay greater than 240 days and greater than 730 days with noncancer related diagnoses," CGS explains. As with the TPE process already announced for home health agencies, MACs will ID 20 to 40 "outlier" claims per provider "through data analysis." In conjunction with the TPE focus, CGS is providing a Comparative Billing Report on non-cancerous diagnoses and length of stay. The CBR, which contains data and information from Sept. 1, 2016, to May 31, 2017, "allows providers to be preemptive in their approach to hospice compliance and Medicare guidelines," CGS says. See the CBR benchmarks broken out by region, as wellas more information on responding to ADRs, at www.cgsmedicare.com/hhh/pubs/news/2017/0917/cope4502.html.
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