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