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Plan of Care denials top Palmetto GBA\u2019s list.<\/em><\/strong><\/span><\/p>\n Another HHH MAC has released preliminary Targeted Probe & Educate review results, and they again bode ill for home health agencies.<\/p>\n HHH MAC\u00a0CGS\u00a0<\/strong>recently issued TPE results indicating that its reviewers found only 20 percent of HHAs that completed TPE round 1 review \u201ccompliant,\u201d and thus able to get off the program, in TPE\u2019s first six months. That compares to 5 percent of HHAs found compliant under Probe & Educate round 1 for CGS and 15 percent for\u00a0Palmetto GBA<\/strong>.<\/p>\n Now, HHH MAC Palmetto GBA has released TPE stats. Instead of releasing figures on how many providers \u201cpassed\u201d TPE, Palmetto<\/p>\n says that its reviewers have denied (either partially or fully) 30.7 percent of the claims they have examined under the program thus far. In other words, the MAC denied 1,671 claims out of 5,442 reviewed.<\/p>\n Palmetto has also divulged that 217 of the 2,131 HHAs targeted under TPE have completed round 1 of the program as of May 23, a MAC spokesperson says. That\u2019s a far larger number than the 15 agencies that completed TPE round 1 by March 31 at CGS.<\/p>\n Unlike CGS, Palmetto did not reveal its error rate cut-off point for getting off TPE. CGS said its was 25 percent.<\/p>\n Palmetto has released the top denial reasons under TPE, although it hasn\u2019t quantified them. They are, in order:<\/p>\n Stay tuned:<\/span>\u00a0<\/strong>\u201cPalmetto GBA will publish the results of round 1 once all providers have completed round 1,\u201d the Palmetto spokesperson says. The results will \u201cinclude charge denial rate and top granular denials to include education to avoid these errors in the future.\u201d<\/p>\n F2F Lower On Denial List Than Expected<\/strong><\/span><\/p>\n Palmetto\u2019s top denial reasons aren\u2019t a surprise, says reimbursement expert\u00a0M. Aaron Little\u00a0<\/strong>with\u00a0BKD\u00a0<\/strong>in Springfield, Missouri. Most of them also showed up in CGS\u2019s list.<\/p>\n What is a little unexpected is that F2F is the number-three reason, rather than one or two, notes\u00a0Joe Osentoski<\/strong>, reimbursement recovery & appeals director for\u00a0QIRT\u00a0<\/strong>in Troy, Michigan. \u201cThis is actually a hopeful sign that it is not the top denial reason,\u201d Osentoski says. Of course, some of the F2Frelated denials might also be grouped in with the other categories, he cautions \u2014 it will be hard to tell until Palmetto issues its granular denial details.<\/p>\n Osentoski suspects that the \u201cno order denial reason is mostly missing recertification estimates by the physician,\u201d he adds.<\/p>\n Source- SuperCoder<\/span><\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"\n