Tag: MAC

CMS reminds providers to use submit claims using SSN-free Medicare cards

Agencies have about four months to ensure they submit all claims using new Medicare beneficiary identifiers (MBIs). Providers will be required to use those MBIs on claims beginning Jan. 1, 2020. CMS completed all seven waves of its mailings earlier this year, and the push to transition to the new MBIs is ongoing. The federal […]

Home health agencies continue to struggle on targeted probe-and-educate review

Of CGS’ 81 probes completed for eligibility and medical necessity edit 5A000 from Jan. 1, 2019, through March 31, 2019, only two were compliant after Round 1 — 79 agencies advanced to Round 2. Nineteen providers didn’t respond to additional documentation requests (ADRs) for Round 1 during that timeframe. Meanwhile, of CGS’ 10 probes completed […]

CMS posts Review Choice Demonstration teleconference schedule

Medicare Administrative Contractor (MAC) Palmetto GBA is inviting Florida, Illinois, North Carolina, Ohio and Texas to attend monthly Review Choice Demonstration teleconferences. The next call is slated for 10 a.m. to 11 a.m. EST Nov. 7. View a full list of upcoming calls. Source: Home Health Line.

CGS to hold webinar about RAPs

By Home Health Line. Medicare Administrative Contractor (MAC) CGS is holding a webinar 1 p.m. to 2 p.m. EST Nov. 15 to discuss a transmittal that provides instructions to MACs about monitoring home health agencies’ misuse of requests for anticipated payment (RAPs). “We will discuss the implications to you as a home health provider,” CGS’ […]

Reconsideration requests under quality reporting program now electronic-only

by Home Health Line. Agencies looking to have a Medicare Administrative Contractor (MAC) reconsider the decision to reduce the agency’s annual payment update over noncompliance with the home health quality reporting program (HHQRP) now have only one option: to submit the request letter electronically. Agencies that do not submit the required quality data for the […]

CMS adds targeted probe and educate to the Medicare program integrity manual

by Home Health Line. CMS has issued a change request to add a targeted probe and educate sub-section to the Medicare program integrity manual. The information will be added to the third chapter, which deals with verifying potential errors and taking corrective actions, according to change request 10876. The change takes effect Sept. 17, 2018. […]

Palmetto’s top denial reasons for hospice include notice of election issue

by Home Health Line. Of the 26 hospice claims denied by Medicare Administrative Contractor (MAC) Palmetto GBA between April and June 2018, the majority were due to failing to supply medical records in response to Additional Documentation Requests (ADRs), Palmetto data show. The second most-common denial code was 5CNER (The notice of election is invalid […]

CMS issues guidance for handling insufficient documentation, ADRs

This post originally appeared on Revenue Cycle Advisor and has been republished with permission. CMS issued change request (CR) 10778 on June 15, with an effective date of July 17, to update Chapter 12 of the Medicare Program Integrity Manual. The proposed update includes details for handling non-responders and insufficient responses to additional documentation requests […]

MAC Palmetto GBA releases many claims that were ‘incorrectly suspended’

Brought to you by Home Health Line. Many home health agencies were taken aback in early June after receiving what appeared to be additional documentation requests (ADRs) from SafeGuard Services LLC, a Unified Program Integrity Contractor (UPIC). But it appears some claims were “incorrectly suspended,” according to a post on Medicare Administrative Contractor (MAC) Palmetto […]

CMS proposes to resume pre-claim demo, potentially expand it to more states

Brought to you by Home Health Line. CMS is seeking public input into relaunching a pre-claim review demonstration for home health services. States that are potentially affected are located within the Medicare Administrative Contractor (MAC) Palmetto GBA’s jurisdiction. “CMS proposes initially implementing the demonstration in Illinois, Ohio, North Carolina, Florida and Texas with the option […]