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Home Health & Hospice Week

Industry Note:

HHH MAC Denies Hospice Claims With Vague Diagnoses As Non-Terminal

Published on Wed Aug 08, 2012

Don't submit a claim with one of these diagnoses, unless your documentation thoroughly backs it up -- Debility, Alzheimer's disease, and Chronic Airway Obstructions. HHH Medicare Ad-ministrative Contractor CGS is continuing a widespread review of hospice claims with these diagnoses, it says on its website.In a probe review that ran from October 2011 through March 2012, CGS denied most claims for failing to show the terminal prognosis or for certifications that were missing, incomplete or not timely, the MAC says. Hospices also failed to submit documentation at all in response to the ADR.Reminder: "The patient's appropriateness for the hospice benefit must be clearly supported in the medical record from admission and throughout the hospice care provided," CGS tells hospices. Look to local coverage decisions for tips on improving documentation of the terminal prognosis, the MAC adds.
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