Practitioner-level articles, OIG Work Plan compliance guides, and reference documents for hospice, home health, primary care, and behavioral health providers billing Medicare and Medicaid. Written by credentialed RCM and compliance professionals — not content marketers.
Monthly OIG LEIE screening is a Conditions of Participation requirement — but the obligation extends well beyond employed clinical staff. Contracted physicians, per diem aides, and third-party vendors billing under your provider number all carry individual exclusion risk. Most independent hospice operators in Georgia screen their W-2 employees and stop there. This article maps the full scope of the obligation, the False Claims Act exposure when it's not met, and what a defensible monthly screening program actually looks like.
Palmetto JM HHH's current Targeted Probe and Educate focus areas for hospice include Beneficiary Sharing, Long-LOS documentation, Routine Home Care claims, and Face-to-Face encounter compliance. Each carries a specific denial code, a documentation standard, and a correction pathway. Here's what the edit data shows.
The FY 2026 aggregate cap rate is $35,361.44 per beneficiary. For a 40–60 census hospice approaching that threshold, the difference between a cap liability and a clean year is usually documentation volume and length-of-stay distribution — not census size. This piece walks through the mechanics and where independent operators should be running their numbers now.
Reason Code 56900 — insufficient documentation to support the need for skilled care — accounts for nearly half of all home health denials processed by Palmetto JM HHH. It's a documentation failure, not a clinical one, and it's almost always preventable at intake and OASIS completion. This article maps the specific documentation elements auditors look for and the intake workflow that closes the gap.
Independent behavioral health, psychology, and psychiatric practices billing Medicare/Medicaid
Covers psychotherapy documentation, E/M leveling in psychiatric settings, telehealth billing post-PHE, and the documentation gaps that generate the highest overpayment rates in behavioral health claims.
Independent and small-chain HHAs operating under Palmetto JM HHH
F2F encounter documentation, OASIS-E2 transition compliance, PDGM coding integrity, and the Reason Code 56900 denial pattern that accounts for nearly half of all Palmetto HHA denials.
Solo and small-group primary care, DPC, and internal medicine practices billing Medicare
The highest-density OIG audit surface of any specialty. E/M level distribution, AWV documentation, CCM billing, modifier 25 frequency, and split/shared visit billing under the 2024 rule revision.
Independent hospice operators — especially those under Palmetto JM HHH or in PPEO states
GIP documentation, aggregate cap exposure mechanics, election statement and Addendum compliance, HOPE implementation, and the PPEO prepayment review posture. Written against 42 CFR Part 418 and Palmetto LCD L38655.
Medical spas and aesthetic practices billing any Medicare-reimbursable services
Covers LegitScript certification, Georgia GCMB Nurse Protocol Agreement requirements, Cosmetic Laser Services Act compliance, and OIG audit exposure on Medicare-reimbursable services billed alongside aesthetic procedures. In production — email us to be notified at launch.
Every guide and article includes a pathway to the consulting engagement that validates its findings at the claims level. If you read something and recognized a pattern in your own billing data, that's the signal. Schedule a discovery call and we'll scope the right engagement from there.