Palmetto GBA Announces Review for Select Home Health HIPPS Codes

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Tuesday, January 28, 2014
by: VNAA Policy Team

Section: Public Policy and Advocacy

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Palmetto GBA is performing service-specific prepay probe reviews on claims billed for selected home health Health Insurance Prospective Payment System (HIPPS) codes. External and internal analysis identified select HIPPS codes as major risk services.

Audits are set for four regions within Jurisdiction 11:
·         Midwest (Illinois, Indiana and Ohio)
·         Southeast (Kentucky, North Carolina, South Carolina and Tennessee)
·         Southwest (Arkansas, Louisiana, New Mexico, Oklahoma and Texas)
·         Gulf Coast (Alabama, Florida, Georgia and Mississippi)

Providers who receive an Additional Documentation Request (ADR) must submit the requested medical record information within 30 days. Finalized claims will receive full or partial payment, or a denial. Providers may request a redetermination within 120 days if they disagree with the decision. Individual providers with significant denials may receive one-on-one education. Completed review results will be available on the Palmetto GBA Web Site.

For more information, please visit Palmetto GBA.

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