Home Health & Hospice Week

Pointer: Use your own docs to persuade colleagues to improve documentation.

So often for hospice patients, claims denials hinge on the patient's certification or recert. Look to recent results from the Comprehensive Error Rate Testing program to help you avoid cert landmines.

In the latest time period, "all CERT errors for hospice providers were related to the hospice certification/recertification," says HHH Medicare Administrative Contractor CGS in a newsletter for providers. Sometimes hospices simply failed to submit the cert to the CERT contractor. But in other cases, the cert had other problems.

Example #1: For one patient, the CERT contractor found the documentation to be insufficient. The documentation "lacked the specific clinical findings and explanation of why the clinical factors supported the six month prognosis," CGS explains.

The hospice under CERT review is hardly alone. "The most common problem area that we see is insufficiently documented certifications," says consultant Beth Carpenter with Beth Carpenter and Associates in Barrington, Ill.

Example #2: For another patient, the cert was late. "The physician's certification was not received until 2 weeks after hospice care began," CGS notes.

Don't forget: "According to the Medicare Benefit Policy Manual, the hospice must obtain oral or written certification of the terminal illness no later than 2 calendar days after hospice care is initiated, and must be signed prior to the submission of the claim," CGS reminds hospice providers.

Note: CGS's article is at http://cgsmedicare.com/hhh/pubs/mb_hhh/2012/06_2012/index.html#004.