% $0 $ % $1,954,710 $177, % $0 $ % $0 $ % $118,444 $59, Mississippi

Transcription

1 ATTACHMENT A Palmetto GBA Hospice Cap Overpayments by State As of May 3, 26 Item State Total % completed Total O/P Average O/P # Code State Providers Completed With O/P with O/P Amount Amount Alabama % $2,6,698 $294, Arkansas 39 % $ $ 3 Florida 4 % $ $ 4 Georgia % $,94,7 $77,7 4 Illinois 4 8 % $ $ 6 Indiana 83 7 % $ $ 7 8 Kentucky 24 % $ $ 8 9 Louisiana % $8,444 $9,222 9 Mississippi % $2,3 $38,34 32 New Mexico % $6,9 $6,9 34 North Carolina 79 2 % $,47 $, Ohio 33 9% $29,339 $29, Oklahoma 4 36% $867,44 $26, South Carolina % $4,432, $443,2 44 Tennessee 8 % $ $ 6 4 Texas % $6,46,366 $24,8 TOTAL, % $6,999,23 $7,64

2 ATTACHMENT A Palmetto GBA Hospice Cap Overpayments by State As of May 3, 26 Item State Total % completed Total Cap O/P Average O/P # Code State Providers Completed With O/P with O/P Amount Amount Alabama % $2,6,698 $294, Arizona 4 % 3 4 Arkansas 39 % 4 California % 6 Colorada % 6 7 Connecticut 2 % 7 8 Delaware % 8 9 Washington DC % 9 Florida 4 % Georgia % $,94,7 $77,7 4 Illinois 4 8 % 2 Indiana 83 7 % 3 6 Iowa % 4 7 Kansas 2 % 8 Kentucky 24 % 6 9 Louisiana % $8,444 $9, Massachusetts 4 % 8 23 Michigan 3 % 9 24 Minnesota % 2 Mississippi % $2,3 $38, Missouri 3 % Nebraska 3 % Nevada % 24 3 New Jersey % 32 New Mexico % $6,9 $6, New York % North Carolina 79 2 % $,47 $, Ohio 33 9% $29,339 $29, Oklahoma 4 36% $867,44 $26, Pennsylvania % 3 42 South Carolina % $4,432, $443, South Dakota % Tennessee 8 % 34 4 Texas % $6,46,366 $24, Utah % Virginia % 37 West Virginia % 38 2 Wisconsin % $44,4 $44,4 TOTAL, % $7,43,64 $26,84 TOTAL for 24 Cap Year % $9,83,644 $338,939

3 Attachment B The Non-Cancer Length of Stay Rate (NCLOS Rate) Provider Specific allow Palmetto GBA to: Characterize its entire hospice provider population Identify trends Focus education and medical review. are calculated using the following formula*: Number of non-cancer beneficiaries with LOS >2 Total number of non-cancer beneficiaries *NCLOS Rate values can range from : no beneficiaries had stays > 2 days, to : all had stays > 2 days. The units are per beneficiaries (e.g., a NCLOS Rate of. means that beneficiaries out of had stays > 2 days) Run Date 4//26 Source: Medicare Statistical Analysis Department

4 Types of All Categories: Data are now being reported by these specific ICD--CM Categories and no longer by LCD/Policies: Certain Conditions Originating in the Perinatal Period Complications of Pregnancy, Childbirth, and the Puerperium Congenital Anomalies Diseases of the Blood and Blood-Forming Organs Diseases of the Circulatory System Diseases of the Digestive System Diseases of the Genitourinary System Diseases of the Musculoskeletal System and Connective Tissue Diseases of the Nervous System and Sense Organs Diseases of the Respiratory System Diseases of the Skin and Subcutaneous Tissue Endocrine, Nutritional and Metabolic Diseases, and Immunity Disorders Infectious and Parasitic Diseases Injury and Poisoning Mental, Behavioral and Neurodevelopmental Disorders Symptoms, Signs, and Ill-Defined Conditions Run Date 4//26 Source: Medicare Statistical Analysis Department 2

5 Distribution of Hospice by State October, March 3, 26 Alabama Run Date 4//26 Source: Medicare Statistical Analysis Department 3

6 Distribution of Hospice by State October, March 3, 26 Arkansas Run Date 4//26 Source: Medicare Statistical Analysis Department 4

7 Distribution of Hospice by State October, March 3, 26 Florida Run Date 4//26 Source: Medicare Statistical Analysis Department

8 Distribution of Hospice by State October, March 3, 26 Georgia Run Date 4//26 Source: Medicare Statistical Analysis Department 6

9 Distribution of Hospice by State October, March 3, 26 Illinois Run Date 4//26 Source: Medicare Statistical Analysis Department 7

10 Distribution of Hospice by State October, March 3, 26 Indiana Run Date 4//26 Source: Medicare Statistical Analysis Department 8

11 Distribution of Hospice by State October, March 3, 26 Kentucky Run Date 4//26 Source: Medicare Statistical Analysis Department 9

12 Distribution of Hospice by State October, March 3, 26 Louisiana Run Date 4//26 Source: Medicare Statistical Analysis Department

13 Distribution of Hospice by State October, March 3, 26 Mississippi Run Date 4//26 Source: Medicare Statistical Analysis Department

14 Distribution of Hospice by State October, March 3, 26 New Mexico Run Date 4//26 Source: Medicare Statistical Analysis Department 2

15 Distribution of Hospice by State October, March 3, 26 North Carolina Run Date 4//26 Source: Medicare Statistical Analysis Department 3

16 Distribution of Hospice by State October, March 3, 26 Ohio Run Date 4//26 Source: Medicare Statistical Analysis Department 4

17 Distribution of Hospice by State October, March 3, 26 Oklahoma Run Date 4//26 Source: Medicare Statistical Analysis Department

18 Distribution of Hospice by State October, March 3, 26 South Carolina Run Date 4//26 Source: Medicare Statistical Analysis Department 6

19 Distribution of Hospice by State October, March 3, 26 Tennessee Run Date 4//26 Source: Medicare Statistical Analysis Department 7

20 Distribution of Hospice by State October, March 3, 26 Texas Run Date 4//26 Source: Medicare Statistical Analysis Department 8

21 ATTACHMENT C st Quarter 26 - Hospice Reversal Rate st Quarter 26 - Totals by State Redetermination Redetermination QIC ALJ Disposition Jan Feb Mar Total Percent State Affirmed Dismissed Reversed State Affirmed Dismissed Reversed State Affirmed Dismissed Reversed Affirmed % AL AL AL Dismissed % AR 7 AR AR Reversed % AZ AZ AZ Total Cases % CO CO CO QIC DE DE DE Disposition Jan Feb Mar Total Percent FL 32 9 FL 49 2 FL Affirmed % GA GA GA 3 Dismissed.47% IL 4 8 IL 8 IL Reversed % IN 23 IN 9 IN Total Cases % KS KS KS ALJ KY 3 KY KY 2 Disposition Jan Feb Mar Total Percent LA 44 2 LA 7 LA Affirmed % MA MA MA Dismissed.% MI MI MI Reversed % MO MO MO Total Cases 9 % MS 7 4 MS MS NC 2 NC 6 NC NE NE NE NJ NJ NJ NM NM NM OH 9 2 OH OH OK OK OK PA PA PA SC 4 SC 8 3 SC 2 TN 2 4 TN 2 TN TX 78 3 TX 4 TX VA VA VA WV WV WV Total Total 27 6 Total 2 8

22 ATTACHMENT D Annual CERT Report November, 24, to October 3, Total claims: 34 Total dollars: $,4,43.79 Total paid: 264 Total paid dollars: $922,.96 Total denied: 76 Total denied dollars: $29,3.83 Denied claims with error code - insufficient documentation: 3 Denied claims with error code - medical necessity: 7 Denied claims with error code - not covered or unallowable service: Denied claims with error codes - incorrect coding: