Last Thursday, Kathy Messerli and Vickie Brand (MHCA Medicare Nurse Consultant), attended a meeting at the National Government Services (NGS) headquarters in Indianapolis. The intent of the meeting was to bring together representatives from home care state associations and leaders from NGS for the purpose of finding ways to increase collaboration and communication with each other. NGS is a home health and hospice Medicare contractor for 20 states. They are responsible for paying Medicare claims, educating providers/agencies, regulatory oversight, and reviewing medical records for payment errors.
The meeting was a great success! Home care representatives from 11 different states were able to have an open dialogue with NGS over issues such as face-to-face and the current Targeted Probe and Educate (TPE) review. In particular, the state associations voiced concerns over the high number of claims denied through NGS/Medicare reviews, such as probe and educate, CERTS, RAC, etc. NGS was receptive to these concerns and agreed to work with stakeholders to meet the mutual goal of decreasing denied claims. A task force was formed during this initial meeting to specifically work on the reduction of home health claims denials. According to the most recent NGS data, the top 3 home health denials were:
1. Physician certification was invalid since the required f2f encounter was missing, incomplete, or untimely
2. Documentation did not show therapy services were reasonable and necessary and at a level of complexity which requires the skills of a therapist
3. The requested records were not received within the time limit
This meeting was the first step in what is hoped to be a successful, collaborative relationship between home health agencies and our Medicare contractor. MHCA will continue advocacy efforts with NGS and other governing bodies on behalf of all home health agencies in Minnesota. If you have any questions, please contact Kathy Messerli at email@example.com .