Home Health & Hospice Week
MAC Denies 1 Out Of 10 CH** Claims In Probe
You’d better make sure your documentation for patients with the highest clinical and functional domain scores is bulletproof, because one HHH Medicare Administrative Contractor is putting claims for them through the wringer.
Palmetto GBA announced a service-specific probe for claims with the CH** HIPPS code back in November. The probe reviewed claims for early or late episodes, with a Clinical Severity Level of 3 and Functional Severity Level of 3, the MAC explained. Reviewers focused on OASIS validation, the MAC said.
The results: In nine states, Palmetto fully or partially denied 106 of 886 claims reviewed — 12 percent. Georgia ranked the highest in denials with 24 of 100 claims, while Arkansas ranked lowest with four of 100 claims denied.
Top denial reasons ran the gamut from lack of therapy documentation to plan of care problems to failure to respond to Additional Development Requests. See more denial details via the links at www.palmettogba.com/palmetto/providers.nsf/Docs/Providers~JM Home Health and Hospice~Medical Review~Results.
Home Health & Hospice Week
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Make Sure Your Governing Body Is Up To Tasks Required By CoPs
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Follow 4 Pointers For Governing Body QAPI Compliance
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Examine Your Governing Body's New Responsibilities
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Governing Body's New Duties Go Beyond QAPI
Board must approve Administrator backups, new CoPs say. Under the incoming Conditions of Participation, you [...] - Hospice:
Past Years' Hospice Cap Overpayments A Moving Target
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Will you be one of the 16 percent of agencies with lower ratings? You may [...] - Industry Note:
MAC Denies 1 Out Of 10 CH** Claims In Probe
You’d better make sure your documentation for patients with the highest clinical and functional domain [...] - Industry Note:
Stay On Top Of Hospice Cap Reporting Changes
You might be worried about previous years’ cap-related overpayments (see story, p. 44), but don’t [...] - Industry Note:
Beware HIC Glitch
If you’re trying to look up beneficiary information in the Common Working File and run [...] - Industry Note:
Medicare To Consolidate DME Bidding Rounds
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The second performance year of the Independence at Home Demonstration, which provides chronically ill patients [...] - Industry Note:
Heed 2 LSC Survey Memos
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Tenet To Shed Home Care
Dallas-based health system Tenet Healthcare Corp. plans to sell its home care and hospice business, [...]
