NGS Provides Update on Post Payment Medical Review Areas for Home Health and Hospices

Situation Report | September 8, 2020

As we previously reported in an August 12 alert, the U.S. Centers for Medicare and Medicaid Services (CMS) has authorized the resumption of medical reviews in August. Since that time, hospices and home health agencies have learned that medical reviews administered by the Medicare Administrative Contractors (MACs) will be service-specific post-payment reviews.

Over the past few weeks, National Government Services (NGS), New York’s Medicare Administrative Contractor, has posted the following reviews to the Medical Review section of its website (at

  • Home Health Patient Driven Groupings Model (PDGM) Bill Type 329, Edit 5WGMP/5CGMP and description: Reviewing Claims Billed Under PDGM 1/1/20 to 2/29/20.
  • Hospice Bill Type 81X, 82X, Edit 5FGFP, Revenue Code 0656 and description: General Inpatient Care (GIP) 7 or More Days.

Impacted agencies and providers may have already received additional document requests (ADRs) during the last full week of August. HCA understands that most providers impacted by these reviews will not have a large number of claims affected. Providers should continue to respond to ADRs within 30 days if at all possible and must have documentation submitted within 45 days. MACs have 60 days to review responses to post-payment ADRs.

Notably, Targeted Probe and Educate (TPE) reviews are still suspended, due to the Public Health Emergency, and a future resumption date has not been set.