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Palmetto GBA Conducts Probe and Educate Reviews in Illinois

Posted on Thursday, April 27, 2017 10:57 AM

Due to the pause on the Pre-Claim Review Demonstration, Palmetto GBA will coordinate pre-payment reviews of home health claims that were submitted on or after October 1, 2016 by home health providers in Illinois.

Palmetto GBA will conduct these reviews by using a modified Probe and Educate strategy. Additionally, a sample of five claims from each home health agency will be chosen to conduct these pre-payment reviews.

Claims that won’t be selected for sample are the ones that have pre-claim review decisions on file. This Probe and Educate process is designed to continue evaluation and encourage providers to understand compliance with the Medicare home health eligibility requirements.

The first additional documentation requests (ADRs) were sent on April 27, 2017. Once the ADR responses are reviewed, the clinician will call the home health provider to discuss any claims that are denied or partially denied upon review.

As for Florida, Palmetto GBA will also conduct this probe and educate strategy.

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