Medicare Audits are Rebooting...Ready or Not

Course overview

Like every company around the country, Medicare contractors had interruptions in their business due to the ongoing COVID-19 pandemic. As the public health emergency rages on and providers grapple with Patient Driven Groupings Model (PDGM) growing pains, Medicare program integrity practices are set to resume this fall and with more intense scrutiny than ever before. Are you in-the-know and prepared about what's on Palmetto GBAs radar? During this presentation, Home Health Solutions President J'non Griffin will provide a refresher of the various audits and reviews you would be wise to prepare for now. The Centers for Medicare & Medicaid Services (CMS) has hinted about the scope of the Additional Documentation Requests (ADRs) providers can expect over the coming months, which include: Patient admission source and whether claims accurately reflect a prior inpatient/stay; Telehealth utilization and how it was incorporated into care following CMS waivers due to the pandemic; and, among others, Improper ordering of Medicare home health services by a non-physician practitioner (i.e., nurse practitioner, clinical nurse specialist, or physician assistant) also a pandemic-related waiver considering that Florida's recent scope of practice expansion for Advanced Registered Nurse Practitioners has not yet gone into effect. Before Palmetto GBA starts probing your agency with ADRs and the Review Choice Demonstration (RCD) goes into effect, register now for this timely and topical presentation and get prepared.