Medicare administrative contractor (MAC) Palmetto GBA has announced it’ll implement a targeted review of two HIPPS codes with high denial rates.
 
The key piece of information that’s missing is which HIPPS codes those are. In its announcement of the review, Palmetto indicates it conducted a review to determine the top 20 HIPPS codes “ranked by provider disbursement.” Subsequently, it looked into which of those HIPPS codes were associated with the highest denial rates on medical review.
 
Based on the review, Palmetto may deny affected claims in full or in part. It’s not clear based on the announcement whether Palmetto would deny based on inaccurate HIPPS codes or medical necessity or both.
 
States affected by this review include Illinois, Indiana, Ohio, Kentucky, North Carolina, South Carolina, Tennessee, Arkansas, Louisiana, New Mexico, Oklahoma, Texas, Alabama, Georgia, Florida and Mississippi.