Region A recovery auditor (RAC) Performant Recovery has posted two new complex review topics for home health claims.
 
The first issue will examine claims for patients in their third or later episode for medical necessity. “Medicare covers skilled nursing services when they are reasonable and necessary. Extended nursing care for observation and assessment may not be covered. Claims for nursing services into the third episode and after will be reviewed to determine if all Medicare coverage criteria is (sic) met.”
 
The second issue will assess whether patients on home health service actually have a skilled need. “When a skilled service is needed, dependent services such as home health aide may also be covered. Dependent services are not covered for a patient who no longer needs a skilled service,” the RAC notes.
 
Both review topics affect agencies in Connecticut, Delaware, the District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island and Vermont.
 
Region C RAC Connolly already is pursuing a complex review of medical necessity.