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Home Health & Hospice Week

Hospice:

Intermediary Targets Nursing Home Hospice Claims

Published on Tue Oct 26, 2010

Don't miss a vital hospice certification step for long-stay beneficiaries. Authorities are pretty concerned about the interaction between nursing homes and hospices, but it's still the hospice basics that trip up most claims for long-term care facility residents. Case in point: Earlier this year, regional home health intermediary Cahaba GBA ran a widespread probe review targeting hospice claims for nursing home residents. As a result of the probe's findings, Cahaba will run a continuing widespread probe review that will examine hospice claims for "beneficiaries residing in nursing homes with a length of stay greater than 180 days," the intermediary explains in its November provider newsletter. Top denial: The largest share of denied claims were due to reason code 5PTER -- documentation does not support the terminal prognosis, Cahaba notes. "The patient's appropriateness for the hospice benefit must be clearly supported in the medical record from admission and throughout the hospice care [...]
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