Steps to a Successful PAR
In a game of golf, a par 3 course usually consists of only par 3 holes. In theory, golfers are able to reach the green on their first stroke and then take two putts to get the ball in the hole. No matter the course, most professional golfers will always use a tee to prevent grass from getting between the ball and the club.
In January of 2017, the OIG, in collaboration with a group of compliance professionals, released a Resource Guide (link) to measure the effectiveness of compliance programs. Items 5.27-5.36 emphasize that a Risk Assessment is key to developing an effective Compliance audit/work plan. Identifying current Medicare review targets to consider when developing your Risk Assessment can be time consuming and overwhelming.
MMP’s PAR Tee’s the Ball
Being sensitive to our client’s already over-tasked day, MMP collaborated with RealTime Medicare Data (RTMD), to develop a proprietary Protection Assessment Report (PAR). MMP’s PAR tees the ball by compiling Medicare Fee-for-Service review targets being conducted by:
- Office of Inspector General (OIG),
- Medicare Administrative Contractors (MACs) – all 12 Jurisdictions,
- Recovery Auditors – all 4 Regions,
- Supplemental Medical Review Contractor (SMRC), and
- Comprehensive Error Rate Testing (CERT) Program.
Additional features of the PAR:
- Inpatient reviews targets that are included in the Program for Evaluating Payment Patterns Electronic Report (PEPPER) are highlighted in the PAR,
- The PAR details all Medicare Contractors that may be focused on one specific review target (i.e., total knee arthroplasty).
- Monthly, MMP Associates monitor websites for the entities listed above. Specifically, monitoring is for new review targets, review results, and new or changes to current coverage policies.
- For review targets with an applicable National Coverage Determination (NCD), Local Coverage Determination (LCD), or Local Coverage Article (LCA), the PAR also includes this information.
Successful Shot Selection
One step to improving your golf game is picking a target to use as a reference for setting up your shot. MMP’s PAR aids in your successful review target selection. This is accomplished by “dropping in” your hospital specific Medicare Fee-for-Service paid claims data (volume, charges and payments), provided by RTMD, for target areas included in the report. Sorting by volume and or payments helps you take aim on what is important for your hospital.
Third Wednesday of the Month PAR Focus
Moving forward, the third Wednesday@One of each month will include insights from our ongoing monitoring of external auditor’s websites. If you are interested in learning more about the PAR, you can contact us by completing the form below this article.
Article Author: Beth Cobb, RN, BSN, ACM, CCDS
Beth Cobb, RN, BSN, ACM, CCDS, is the Manager of Clinical Analytics at Medical Management Plus, Inc. Beth has over twenty-five years of experience in healthcare including eleven years in Case Management at a large multi-facility health system. In her current position, Beth is a principle writer for MMP’s Wednesday@One weekly e-newsletter, an active member of our HIPAA Compliance Committee, MMP’s Education Department Program Director and co-developer of MMP’s proprietary Compliance Protection Assessment Tool.
