"Engaging McBee’s Home Health Services, we were able to identify & collect $123,000 of lost revenue."
Member, National Provider Association
Due to the success of the Probe and Educate pilot from June 2016 to July 2017, CMS has announced that it will expand the initiative to all Medicare providers.
As stated in the announcement, “As a result of the successes demonstrated during the pilot, including an increase in the acceptance of provider education as well as a decrease in appealed claims decisions, CMS has decided to expand to all MAC jurisdictions later in 2017.”
What does this mean for Home Health Agencies? MACs will review of 20-40 claims per provider, per item or service, per round, for a total of up to three rounds of review.
If the review reveals a moderate or high error rate in the first review, Medicare will conduct individualized education sessions to address medical billing errors found in the reviewed claims. The agency will receive another audit in 45 days.
This will cause a delay in payments. However, if an agency overall compliant in their first review, then they will not receive another audit for 12 months.
It will be critical home health agencies are prepared for these audits to prevent any further disruption in payments.