Friday, August 30, 2013

Utah Home Health Widespread Edit Probe

CGS issues Widespread Home Health Edit Probe for Utah Home Health Agencies.  This was issued based on their recent analysis of billing data for home health agencies in Utah compared to home health agencies in other states served by CGS.  The analysis showed the state of Utah provider’s averaged higher reimbursement per claim, higher average total therapy visits, higher percent of claims with therapy services and higher percent of claims with 20+ therapy visits. 

The topic code for this review will be 5012W, and the probe will select claims with 10 or more therapy visits.  Once selected, the claims will be reviewed for valid FTF encounter documentation, medical necessity, compliance with all CMS coverage guidelines, and correct billing and coding.

For more information please utilize the following link:


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