Phase three of CMS’s probe and educate is underway. The first wave of letters is in the mail. Your agency will be in this first round if you failed to respond to previous ADR requests, if you had two or more denials, if you were offered education but did not participate, or if your agency did not show improvement.
CMS asserts that through the Targeted Probe and Educate, MACs “will focus only on providers/suppliers who have the highest claim error rates or billing practices that vary significantly out from their peers,” the agency said. But the MACs are combing through mountains of data from every single agency in the country and if your agency has errors, they will be found.
Many will be targeted, but few agencies are experienced enough with ADRs to provide the robust response that will be necessary when that letter arrives. Do not be caught unprepared.
Have questions about where to begin? Come learn from Joe Osentoski, one of the country’s leading experts on home health compliance. Attend the ADR to Appeal Primer and find out how Mr. Osentoski earned his reputation and his phenomenal 96% overturn rate at the ALJ level. Improve your agency’s chances of success with the Targeted Probe and Educate.