Home Health & Hospice Week

CERT reviews turn up problems proving skilled need for home health patients.More reviewers than ever are poring over your claims, and home health agencies are vulnerable on a key point -- medical necessity.Lack of medical necessity was among the top denials for home health agency claims in the latest Comprehensive Error Rate Testing (CERT) results, notes HHH Medicare Administrative Con-tractor CGS in its June newsletter for providers. Medical necessity denials can be particularly pain-ful financially, since reviewers then can deny the entire episode instead of just downcoding its case mix category.Example #1: One CERT case focuses on a diagnosis MACs have been running edits for, hypertension. For this HTN patient, "no blood pressure parameters were noted in the plan of care (POC), and there were no changes to the Coumadin dosage," CGS tells providers. "Documentation supported that the patient was stable with no changes in diagnosis, medications, treatment plan of care, [...]