New Vendor to Perform Audits in November

Premera Blue Cross has engaged Performant Recovery, Inc. (business name Performant Healthcare Solutions) to conduct chart audits of durable medical equipment (DME), home infusion therapy (HIT), home health (HH), and skilled nursing facility (SNF) claims. These chart audits will start in early November 2024.

DME and HIT audits will review medical records for a broad range of factors to ensure adherence to coverage and reimbursement policies. Audit parameters include:

• Proper documentation of written orders and proof of delivery
• Correct Healthcare Common Procedure Coding System (HCPCS) procedure codes to represent equipment/supplies delivered
• Prescribed and delivered units compare to those billed by the provider

HH and SNF audits will review medical records for coding and documentation review for coverage and reimbursement accuracy consistent with payer specific contract and industry criteria.

The Performant Healthcare Solutions audit team includes physicians, Medicare trained auditors, registered and licensed nurses, and certified coders.

Audit letters will be sent under the Performant name to request medical records and/or chart notes and send audit results. The letters will outline specific timelines for providers to respond to their findings.