CMS issues guidance for handling insufficient documentation, ADRs

This post originally appeared on Revenue Cycle Advisor and has been republished with permission.
CMS issued change request (CR) 10778 on June 15, with an effective date of July 17, to update Chapter 12 of the Medicare Program Integrity Manual. The proposed update includes details for handling non-responders and insufficient responses to additional documentation requests (ADR) under the Comprehensive Error Rate Testing (CERT) program.
The most common cause of improper payments (accounting for 64.1% of total improper …

New Medicare cards: What’s that square code?

CMS published an announcement explaining that some of the new Medicare cards may have a square code, also referred to as a QR code (a type of machine-readable code).
“The QR codes on Medicare cards allow the contractor who prints the cards to ensure the right card goes to the right person with Medicare or Railroad Retirement Board (RRB) benefits. Providers cannot use it for any other purpose. The RRB issued cards may have a QR …

CMS updates quality measure table to align with revised CoPs

Brought to you by Home Health Line.
CMS has recently posted an updated home health process quality measure table as a result of the revisions made to the timely initiation of care measure. The document was modified to further align with the revised Home Health Conditions of Participation (CoPs), which took effect Jan. 13.
Under the revised CoPs, CMS now allows for a physician-ordered resumption of care (ROC) date beyond 48 hours for patients coming from an …

MAC Palmetto GBA releases many claims that were ‘incorrectly suspended’

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Many home health agencies were taken aback in early June after receiving what appeared to be additional documentation requests (ADRs) from SafeGuard Services LLC, a Unified Program Integrity Contractor (UPIC).
But it appears some claims were “incorrectly suspended,” according to a post on Medicare Administrative Contractor (MAC) Palmetto GBA’s website.
UPICs help address fraud, waste and abuse by performing regional Medicare and Medicaid data analysis, complaint resolution and investigative activities, according …