Recovery Audit Contractor Adds Continuous Home Care Issue

The Recovery Audit Contractor (RAC), Performant, added a hospice issue this month to the list of CMS-approved issues, Issue 0201 – Hospice Continuous Home Care: Medical Necessity and Documentation Requirements. The review will determine if hospice Continuous Home Care (CHC) services were reasonable and necessary to achieve palliation and management of the patient’s acute medical…

Recovery Audit Contractor (RAC) Issues Pertaining to Hospice

Hospices should be aware of the following Recovery Audit Contractor (RAC) issues pertaining to hospice patients. Physician Services During Hospice Period – 8/16/2018 DME While in Hospice – 9/20/2018 Outpatient Hospice-Related Services – 11/28/2018 Each of these issues looks at non-hospice providers and whether the reason for the service is related to the hospice diagnosis.…

CMS Proposes to Begin RCD on December 10, 2018

The Centers for Medicare & Medicaid Services has issued a second Paperwork Reduction Act (PRA) notice for public comment for the Home Health Pre-Claim Review Demonstration (A.K.A. Review Choice Demonstration). This notice is for a 30-day public comment period CMS proposes to initially implement the demonstration in Illinois, Ohio, North Carolina, Florida, and Texas with…

Report: Improvements Needed to Prevent Medicaid Managed Care Payment Risks

The Centers for Medicare & Medicaid (CMS) should require states to report and document the amount of overpayments by managed care organizations to providers in order to eliminate improper payments, according to a new study from the Government Accountability Office (GAO). Under this Medicaid model, states pay a set periodic amount to MCOs for each beneficiary and…

Recovery Audit Contractor to Conduct Home Health Reviews

The Recovery Audit Contractor (RAC) Performant Recovery, Inc. will be conducting a complex home health review for documentation and medical necessity, according to an announcement from the Centers for Medicare & Medicaid Services (CMS). The announcement was posted January 10, 2018. The review will be for all Region 5 “HHA MACs except for the following…