Tell NAHC About Your Probe and Educate Audit Results

Tell NAHC About Your Probe and Educate Audit Results

Has your Medicare administrative contractor (MAC) requested five home health patient records for pre-payment review?

  • Did the MAC deny payment for any of them?

    If you answer yes to either question, the National Association for Home Care and Hospice (NAHC) needs your help.

    NAHC wants to know:

    1. The reason for the denial as issued to agency by the contractor.
    2. Medical records sent to the contractor for review
    3. 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.
    4. Evidence that disputes the findings by the contractor
    5. Any denials overturned on appeal  
      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 or contact me at 202-547-7424."

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