Home Health Claims Probe & Educate - 11/16/2015

CMS Released MLN Matters Number SE1524 last week concerning a new home health claim probe and educate review.  You Medicare Administrative Contractor (MAC – PlamettoGBA, CGS or NGS) will request 5 claims from each Medicare certified home health agency.  This probe and educate review will concentrate on the area of reviewing to determine if the home health services provided to the patient meets the eligibility requirements.  The real focus will be on the compliance with the latest CMS interpretation of the face to face requirement that was issued in the final rules home health payment CMS-1611-F. 

Each home health agency will be required to submit documentation to support the 5 claims selected for review.  If MAC finds problems with one or fewer claims the agency will be classified into the category of “No or Minor Concerns”.  If the MAC finds problems with two or more of the claims the agency will be classified into the category of “Moderate/Major Concerns”. 

For your information please utilize the following link

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1524.pdf