Performant, the national home health, hospice, and DMEPOS recovery audit contractor (RAC), added two new items to their CMS approved audit issues list. Both are identified as complex reviews, meaning providers that bill these services could be subject to ADR letters for postpayment review. See details below.
Wearable Automatic External Defibrillators: Medical Necessity and Documentation Requirements
DATES SERVICE: Exclude from review claims having a “claim paid date” which is more than 3 years prior to the ADR date, and Dates of Service prior to January 1, 2020.
DESCRIPTION: This review will determine if a Wearable Automatic External Defibrillator is reasonable and necessary for the patient’s condition based on the documentation in the medical record.
AFFECTED CODES: K0606, K0607, K0608, K0609
Medical Supplies Billed from Consolidated Billing List During a Home Health Episode: Unbundling
DATES SERVICE: Algorithm excludes claims that have a “claim paid date” which is more than 3 years prior to the Informational Letter date (automated review).
DESCRIPTION: All Medical Supplies Billed from Consolidated Billing List billed after the admit date of a patient to Home Health services and before the discharge date of a patient from Home Health services or any claims billed after the admit date of a patient to Home Health services and null discharge date (when patient status code is equal to 30), are inclusive to Home Health services.
AFFECTED CODES: Consolidated Billing Master Supply List - non-routine supply codes, found here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service- payment/HomeHealthPPS/coding_billing.html
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