Home Health & Hospice Week

Avoid denials with this official guidance. If you're getting denied for osteoporosis drug injections, you aren't alone -- and the Centers for Medicare & Medicaid Services has taken note. Problem: Many claims submitted for covered osteoporosis drugs don't provide a date of service that falls within the start and end dates of an existing prospective payment system (PPS) episode, according to a recent MLN Matters article. Medicare outlines three criteria for covering injectable osteoporosis claims: • Patients are eligible for home health services; • Physicians certify that the individual sustained a bone fracture related to post-menopausal osteoporosis; and • Physicians certify that the female patient can't self-administer the drug and no caregivers are able to administer it for her. That first criterion is where most agencies stumble, CMS says. Crucial: Eligibility hinges on agencies providing the service during the health care episode -- for instance, if the claim contains HCPCS codes [...]