Home Health & Hospice Week

Make sure your documentation for episodes that barely exceed the LUPA threshold will stand up to scrutiny, or you could face steep denials.

In a recent review of home health agency claims containing five to seven visits, HHH Medi-care Administrative Contractor NHIC denied 68 percent of claims, the MAC says on its website. NHIC reviewers denied 33 claims because documentation did not support the skilled nursing services as being medically necessary, the contractor says. "A frequent cause of denials in this situation is when the documentation did not show the need for observation and assessment of the patient's condition," the MAC details. (For tips on understanding O&A and defending against O&A denials, see Eli's HCW, Vol. XXI, No. 17.)

NHIC denied seven claims because it didn't receive documentation timely, the MAC adds.