CMS’ targeted probe-and-educate reviews for home health will consist of three rounds if agencies ensnared in it have a “high payment error rate above 15%,” Medicare Administrative Contractor (MAC) NGS explained during an Oct. 24 webinar.
 
Round 1 will result in a review of 20 to 40 claims per affected provider, and non-responders could be referred to a recovery auditor (RAC), Zone Program Integrity Contractor (ZPIC) or Unified Program Integrity Contractor (UPIC).
 
If providers continue to have high error rates after three rounds of probe-and-educate reviews, NGS says, CMS may instruct the MAC for additional action including: Extrapolation, referral to the ZPIC or UPIC, referral to the RAC or 100% pre-pay review.
 
Related link: Watch an NGS video on targeted probe-and-educate reviews at http://bit.ly/2i3db28.