Prepayment Medical Review on Service Specific HH Claims

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Prepayment Medical Review on Service Specific HH Claims


Excerpt from Palmetto GBA

Palmetto GBA A/B MAC will be performing pre-payment service-specific probe medical review on Home Health claims, utilizing the CH** HIPPS Codes, Early or Late Episodes, Clinical Severity Level 3 and Functional Severity Level 3.

This probe is based on internal data analysis which included prioritization of the HIPPS Codes and will be focused on Oasis validation. Probe edits will be set in Alabama,Arkansas, Georgia, Indiana, Kentucky, Louisiana, Mississippi, New Mexico, North Carolina, Ohio, Oklahoma, South Carolina and Tennessee and will select a sample of 100 claims from each state.  Last Updated: 10/13/2016

See full article here.

We added a report that will pull OASIS meeting the above criteria for episodes within the last 12 months.  Go to Reports and click on Download New Reports,select the OASIS category and scroll down to report 13.63 CH HIPPS OASIS.  Click on Print the Report



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Last Modified:Friday, October 14, 2016

Last Modified By: farrah@barnestorm.com

Type: HOWTO

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