Medicare Compliance & Reimbursement

Use this checklist from one HHH MAC to guide your eligibility assessments. Medical review from Medicare contractors has been somewhat lax under the prospective payment system, but that's all changing now that numerous government bodies and contractors are looking over your records. As review continues to ramp up in the coming months, it will be more important to be able to identify situations when patients qualify for home care, and when they don't. Use these reasons for skilled service need and tips on documenting them from HHH Medicare Administrative Contractor Palmetto GBA to help inform your identification process and strengthen your documentation: 1) New onset or acute exacerbation of diagnosis (include documentation to support signs and symptoms and the date of the new onset or acute exacerbation). 2) New and/or changed prescription medications. Palmetto defines new medications as those the beneficiary has not taken recently, i.e., within the last 30 [...]