Region C recovery audit contractor (RAC) Connolly will review home health and hospice records to determine whether services were medically necessary.
Both review topics are unusual for a RAC, as these contractors usually focus on automated reviews. In addition, RACs have only recently begun reviewing home health claims at all.
The home health issue will entail medical record review "to validate that the Home Health Services provided were both reasonable and medically necessary, and that the patient met the conditions to qualify for Home Health Services," according to Connolly's website.
The hospice record review will "determine that services were medically reasonable and necessary. The beneficiary must demonstrate signs and/or symptoms severe enough to warrant the need for hospital-level medical care and must receive services of such intensity that they can be furnished safely and effectively only on an inpatient basis."
Both issues affect Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, Virgin Islands, Virginia and West Virginia.
You can access the RAC's website here. Look to an upcoming issue of HHL for more details on these new RAC reviews.