Medicare Administrative Contractor Palmetto GBA plans to perform service-specific prepay probe reviews on eight HIPPS codes involving 20 or more therapy visits.
 
The affected codes are 5CHK*, 5CGK,* 5BHK*, 5AHK*, 5BGK*, 5AGK*, 5BFK* and 5AFK* (last digit variable).
 
Palmetto says it determined all eight codes are “major risk services” for its 16-state jurisdiction based upon errors identified from the Comprehensive Error Rate Testing (CERT) program, reports issued by the HHS Office of Inspector General (OIG) and reports issued by the Medicare Payment Advisory Commission (MedPAC).
 
A Palmetto spokesman told HHL that reviews into those codes “may take several months as we issue the Additional Documentation Requests (ADRs), receive the records and review the claims.”