REMINDER: Home Health Probe and Educate Reviews to Begin Oct. 1
September 30, 2015 01:18 PM
In April 2015, the Centers for Medicare & Medicaid Services (CMS) announced its plans to conduct a Probe and Educate review on home health claims to ensure agencies understand the new certification requirements, specifically, the revised Face to Face encounter requirements, effective January 1, 2015.
According to the CMS announcement, reviews will begin October 1, for claims with episodes that begin on or after August 1, 2015. The specifics of the review (number of claim, length of review, education methods, etc.) have yet to be published.
The National Association for Home Care & Hospice is aware that claims reviewed during the Probe and Educate period will be denied if the certification requirements are not met. CMS maintains they have no authority to pay claims where the criteria for Medicare coverage is not evident.
CMS stated in their original announcement that they plan to provide on their web site additional details and information on the Probe and Educate review, however, they have yet to do so. Whether this will delay the Probe and Educate review is unclear, but agencies should expect to see increased medical review activity on home health claims over the next several months.
Agencies are encouraged to check the Medical Review and Education web site frequently for any updates.