Codapedia is now a division of Find-A-Code

PSAVE Pilot Program - What Does it Mean to You?

August 20th, 2018 - Wyn Staheli, Director of Research
Categories:   Medicare   Audits/Auditing   Practice Management  
0 Votes - Sign in to vote or comment.

Noridian, the Jurisdiction F Medicare Administrative Contractor (MAC), recently announced that they will be extending their pilot program: Provider Self-Audit with Validation and Extrapolation (PSAVE). Whenever a program is extended, that means that it has been successful for the payer, which likely means that they are saving money. It doesn’t state precisely HOW they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program.

What is PSAVE?

According to Noridian, “The PSAVE program allows the provider to perform a self-audit after agreeing to waive appeal rights on the universe of claims.” In exchange for waiving their appeal rights, the provider receives immunity from MAC and Recovery Auditor (RA) reviews.

Providers who voluntarily participate in PSAVE receive education on how to perform a self-audit. Noridian then validates the provider's self-audit findings on a subsample of claims. Here’s the catch, based on their findings, they “will extrapolate overpayments or correct underpayments.” The correcting underpayments is nice for the provider, but the extrapolation of underpayments process has been proven to be very costly to providers. CLICK HERE to read more about extrapolation.

According to the Noridian appeals waiver form (emphasis added), “It is important to note that the validation review may result in additional overpayments identified that may have been missed by the provider when the self-audit was conducted.”

Who May Participate?

Invitations to participate were sent to providers who were considered ‘outliers’ by Noridian. This means that their billing practices were already considered questionable. If you were invited, chances are that the self-audit may not prove to be a good option for your practice.

Participation Pros and Cons

Pros

Immunity from MAC and RA reviews could be a significant benefit if your claims are problematic. However, it is essential to note that immunity does NOT extend to Unified Program Integrity Contractor (UPIC) / Zone Program Integrity Contractor (ZPIC) or the Office of the Inspector General (OIG) so that immunity might not be as valuable as you think it is.

The educational aspects could prove to be beneficial to the practice by providing them with instructions to improve their claims and documentation process.

Cons

Waiving your appeals rights could be problematic, especially in situations like we are currently experiencing with the physical therapy denials by several Blue Cross organizations (e.g., Illinois, Texas).

Participation means that the practice will, in most cases, be unable to dispute the findings of the MAC. This is a pretty significant right to give up.

As mentioned earlier, immunity does not extend to all offices/organizations and their audits, so it’s value may be minimal.

Summary

Self-audits are a very good idea. However, we have some concerns about waiving your appeal rights. Rather than wait for a payer to tell you what you are doing wrong, find out yourself with your own self-audit and internally fix the problems immediately.

Note: Information about performing self-audits can be found in Chapter 3 of one of our specialty-specific Reimbursement Guides.

If you are invited to participate in PSAVE in the future, let that be a warning to you that your practice is already being considered for an audit. It should be a wake up call to ensure that your documentation and claims processes are in order.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Scanning the Unscannable: Improving Patient Flow in MRI
January 14th, 2019 - BC Advantage
Stay Ahead of your CEUs in 2019Get the latest webinars and earn over 24 CEUs each year included with your BC Advantage Magazine subscription. Latest Webinar: Scanning the Unscannable: Improving Patient Flow in MRI Presenter: Wendy Stirnkorb, President & CEO Stirnkorb Consulting, LLC Time: 46 Minutes Cost: $0.00 to all BC Advantage Magazine Subscribers CEUs: 1.0 On-demand: Watch 24/7 from work or ...
What is Virtual Communication (G0071)?
January 14th, 2019 - NAMAS
Beginning January 1st, 2019 all of our RHC and FQHC organizations have a new CPT code to consider implementing for their Medicare populous (check per Advantage Plan Administration for coverage). In its current form, this code is not reportable by organizations not meeting the RHC/FQHC designation. The code isG0071 and is termed ...
Nine New Codes for Fine Needle Aspirations (FNA)
January 4th, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
If your practice performs a lot of fine needle aspirations (FNA), you probably have the code options memorized (10021 without image guidance and 10022 with image guidance). However, the 2019 CPT codes now include nine (9) new FNA codes (10004-10012), one deleted FNA code (10022) and one revised FNA code ...
Dry Needling
January 3rd, 2019 - Wyn Staheli, Director of Research
The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ...
2019 Coding Changes for Chiropractic
January 3rd, 2019 - Wyn Staheli, Director of Research
The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...
Are You Ready For the 2019 New Codes
January 3rd, 2019 - Aimee Wilcox, CPMA, CCS-P, CMHP, CST, MA, MT
Many articles have been published regarding the 2019 proposed Evaluation and Management coding changes but hopefully, you have taken the time to review those in detail and be ready for them. If not, here is a link to a Find-A-Code article written by Wyn Staheli (Director of Research) entitled, “Are You Ready ...
Quality Measures Finalized for 2019
December 18th, 2018 - Wyn Staheli, Director of Research
CMS recently announced that the quality measures for 2019 have been finalized. There are new eligible clinicians so be aware of how that may affect your organization. New ECs are: Physical therapists Occupational therapists Qualified speech-language pathologists Qualified audiologists Clinical psychologists Registered dietitian or nutrition professionals The following are changes to Electronic Clinical Quality Measures (eCQMs) available ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association