Cotiviti Healthcare, which previously served as a recovery audit contractor (RAC) for multiple types of health care providers including home health agencies, recently submitted about 71,000 home health claims adjustments to Medicare Administrative Contractor (MAC) Palmetto GBA for recovery.
The MAC will not disclose how much money is being recovered, a Palmetto spokesman tells HHL.
Cotiviti had served as the RAC for Region C, which included 15 states, Puerto Rico and the U.S. Virgin Islands. In September, Cotiviti conducted automated reviews involving validation of late episode timing and validation of early episode timing, according to Palmetto. When claims were submitted with an incorrect treatment authorization code (TAC), the RAC adjusted the HIPPS code. The RAC then directed Palmetto to adjust those claims and recoup funds when overpayments existed.
Agencies that received overpayment demand letters can request a redetermination, a Palmetto release states.
A Palmetto spokesman didn’t know whether Palmetto the only MAC that will be processing claim adjustments due to the RAC review. Cotiviti could not immediately be reached for comment.
In the future, a different RAC — Performant Recovery Inc. — will serve as the first RAC dedicated to a new nationwide home health, hospice and durable medical equipment (DME) region.