Home Health & Hospice Week

One edit of long-stay patients sees 97% denials.Medicare is clamping down on payments for long-stay hospice patients. Can your documentation for patients living longer than the six-month prognosis stand up to scrutiny?HH&H Medicare Administrative Contractor CGS has revealed the results of two edits of long-stay patients. Under edit topic code 5037T, CGS reviewed claims for hospice patients with lengths of stay greater than 730 days and denied 81 percent of reviewed claims. Under edit topic code 5048T, CGS reviewed claims for hospice patients with LOS greater than 999 days and denied a whopping 97 percent of claims.The stats suggest that medical reviewers are getting tougher on long-stay patient claims. The edits' denial rates are up from 69 and 73 percent from the year-ago time period, respectively, CGS reports."The majority of the denials received by providers were related to the six-month [180 days] terminal prognosis not being supported in the documentation," [...]