CMS has two new focuses for medical reviews

CMS to focus on 2 new areas for reviews

At the NAHC conference in Washington, DC, recently, Latesha Walker of CMS said that CMS will begin medical reviews in two new areas:

  • Episodes that barely exceed the low utilization payment adjustment (LUPA) threshold of five visits with document reviews.
  • Review situations where an agency billed a low HHRG code for a first episode, but a higher one later.

Just because there are two new additions doesn’t mean that the old reviews shouldn’t be paid attention to anymore!

A few other things discussed at the meeting:

  • CMS has already set a 1.32 percent cut for case-mix in 2013 because of case-mix creep. CMS is moving ahead with its PPS rebasing project.
  • Confused on assessments and billability of visits with therapy? You’re not the only one. NAHC is still asking for clarification on when an assessment visit is billable (ever?) what is billable if you don’t do the assessment at exactly 30 days or the 13th or 19th visit. What if it’s the 14th visit? When does a visit become billable?
  • New CoP? Really? We’ll believe it when we see it, but Pat Sevast said new Conditions of Participation are on CMS’s to-do list.

Thanks, again, to HCLA for its update in its News Alert!

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