Has your Medicare administrative contractor (MAC) requested five home health patient records for pre-payment review?
If you answer yes to either question, the National Association for Home Care and Hospice (NAHC) needs your help.
NAHC wants to know:
- The reason for the denial as issued to agency by the contractor.
- Medical records sent to the contractor for review
- Information on the contractor’s education received by the agency, such as notes or presentations provided by the contractor, or notes taken by the agency on the education provided by the contractor.
- Evidence that disputes the findings by the contractor
- Any denials overturned on appeal
CMS ordered each MAC to conduct pre-payment reviews of 5 claims from every home health agency in its region. MAC medical reviewers will audit these claims for episodes that began on or after 8/1/ 2015 using a "Probe and Educate" strategy detailed in MLN Matters(r) article #SE1524.
The "Probe and Educate process," according to SE1524, is "to assess and promote provider understanding and compliance with the Medicare home health eligibility requirements," related to the new patient certification requirements concerning face-to-face encounter documentation.
NAHC is gathering information to help in make the case to CMS "that the F2F requirement is actually worse with the revisions," wrote Mary Carr, NAHC's V.P. for Regulatory Affairs, in a message emailed to state home health association leaders. "It will also help us understand what exactly the contractors are telling providers in terms of compliance with the F2F requirement."
Carr asks agencies to "Please respond to me directly at mkc@nahc.org or contact me at 202-547-7424."