CMS has announced that it will expand Targeted Probe & Educate to all Medicare providers. This is due to the success of the Probe & Educate pilot conducted from June 2016 to July 2017.
The pilot increased the acceptance of provider education as well as decreased appealed claim 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 billing errors. 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; they will not receive another audit for 12 months.
It will be critical home health agencies are prepared for these audits by conducting pre-bill audits. Pre-Bill Audits are key in preventing any further disruption in payments.
Mike Dordick, Executive Vice President, Principal–McBee
Mike has more than 20 years experience in health care financial and management consulting. He leads McBee’s Post Acute Division and works with home health and hospice providers to improve clinical outcomes, increase cash flow, and develop best practices in operations.