BCBSM Medicare Advantage PPO home health care and skilled nursing facility audits begin this month

Starting this August, independent contractors will audit Blue Cross Blue Shield of Michigan Medicare Advantage home health care and skilled nursing facility claim payments.

These audits will be performed at the vendor’s office and modeled after the Centers for Medicare & Medicaid Services home health and skilled nursing facility audits. The contractors that will be performing the audits are HealthDataInsights and SCIO Health Analytics.

Home health care and skilled nursing facility services are defined as home health care services that occur within a BCBSM Medicare Advantage member’s home and are provided by home health care companies, including caregiver services, home health nursing, aides and therapists.

A skilled nursing facility provides health and therapeutic services to patients who require residential and continual nursing care. A licensed physician supervises each patient’s care and a nurse or other medical professional is almost always on the premises. Skilled nursing can be made available 24 hours a day.

Additional information will be included in letters sent to facilities.

If you have questions, contact your provider consultant or send an email to efoster@bcbsm.com.