Palmetto Specific HIPPS Code Claim Review

Palmetto GBA will be performing service-specific prepay probe reviews on claims billed for selected Home Health HIPPS codes. Based on identified CERT errors, OIG and Med PAC reports, internal analysis and prioritization, as well as past experience, selected HIPPS codes have been identified as major risk services for J11.Palmetto GBA will be setting five service-specific probe medical review edits for HIPPS code 5CHK* (variable last digit of HIPPS Codes.) These edits will be set to select 100 claims from each of the following states: Florida, Illinois, Louisiana, Texas; and 100 claims from all the remaining 12 states within the jurisdiction.

Palmetto GBA will also be setting four service-specific probe medical review edits for HIPPS Code 5CGK* (variable last digit of HIPPS Codes.) These edits will be set to select 100 claims from each of the following states: Florida, Texas; 100 claims from the following state grouping: Illinois, Louisiana, Mississippi; and 100 claims from all the remaining 11 states within the jurisdiction.

Palmetto GBA will be setting four service-specific probe medical review edits for HIPPS code 5BHK* (variable last digit of HIPPS Codes.) These edits will be set to select 100 claims from each of the following states: Florida, Texas; 100 claims from the following state grouping: Illinois, Louisiana, Mississippi; and 100 claims from all the remaining 12 states within the jurisdiction.

For more information please utilize the following link:

http://www.palmettogba.com/palmetto/providers.nsf/ls/Jurisdiction%2011%20Home%20Health%20and%20Hospice~9FFNBY3126?opendocument&utm_source=J11HHHL&utm_campaign=J11HHHLs&utm_medium=email

CMS Post New Guidance for Homebound Status

CMS published MLN Matters Number SE1405 on January 13, 2014.  This report concerned information related to the requirements for the Face-To-Face Encounters.  It also laid out a brief description on the homebound status that would be required for patients to receive home health care.  It is very important for all home health agencies to carefully document homebound status. 

SE1405 actually listed the narrative requirements to document homebound status including some examples.  This publication will be a good reference for you and your staff.

To download the information please utilize the following link:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1405.pdf

Temporary Hold on Home Health LUPA Claims

Medicare contractors have identified an incorrect payment calculation affecting home health claims that would be paid low utilization payment adjustments (LUPAs). To prevent these claims from paying incorrectly, Medicare contractors will hold all home health LUPA claims with "Through" dates on or after January 1, 2014 until Medicare systems are corrected. This correction should occur in early February, 2014.