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In a recent update regarding Hospice services, it was announced that the extension of prepayment reviews will occur in four states. The states affected by this expanded prepayment review are California, Arizona, Texas, and Nevada. This initiative is part of what’s being referred to as Expanded Targeted Probe and Educate. 

The Targeted Probe and Educate program has been in effect since 2017, except for the period during the Public Health Emergency when Medical Review activities were paused. This program is managed by the Medicare Administrative Contractors (MACs) and follows a clearly defined structure. 

The prepayment reviews are intended to identify fraud, waste, and abuse, but a detailed structure for these reviews has not yet been provided. However, the memo released does indicate that if your Hospice has recently undergone a Targeted Probe and Educate review with your Medicare MAC, your organization will be excluded from the current list for these additional reviews. 

In recent years, these four states have been subject to PPEO Audits, where new providers or those with a 50% or greater change in ownership have been automatically subjected to extended reviews, without exception. 

The Targeted Probe and Educate and the Prepayment Reviews, refers to the point when you submit claims for payment, your charts may be selected for a medical review. At that point, you will need to submit the chart for evaluation, and the payment will only be processed once the medical review is complete. Therefore, it’s important to act quickly in assembling and submitting the necessary charts for these reviews to avoid payment delays. 

When assembling these charts, we strongly recommend submitting a single PDF file that contains all the pages of the chart. This file should be page-numbered, include a table of contents, and have a cover letter that guides the reviewer through the chart. It’s crucial that a clinician reviews the chart beforehand to ensure everything is complete, as missing information could have consequences. 

In many of our recent webinars and MMMs, we’ve covered key details about documentation that can help prevent denials for hospices. We encourage you to visit our website to access those recordings. If you’re an HPS Alliance member, you’ll have full access to all the recorded webinars available on our site. If you’d like more information about HPS Alliance membership, click here. 

HPS stands ready to also assist you with any help you may need in regards to medical review. Should you need assistance, please feel free to reach out to us. 

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