Home Health & Hospice Week
Missed ADR Deadlines Trigger Auto Denials
Make Additional Development Request deadlines or risk auto denials, as one Medicare Administrative Contractor is targeting claims for long-stay hospice patients.
Don’t be late in responding to additional development requests, or you could be very sorry. That’s the message from HHH MAC CGS, which reminds providers that they have 30 days to submit their ADR responses. "If documentation is not mailed within the 30-day request, it may begin to auto-deny unnecessarily," the MAC warns on its website.
This is a pertinent issue for hospices, who have been on the receiving end of multiple widespread edits lately. CGS lists six hospice widespread edits on its website at www.cgsmedicare.com/hhh/medreview/med_review_edits.html, compared to just two edit topics for home health agencies.
The edit generating the most ADRs is 5101T, which selects claims with a length of stay greater than 180 days and a primary diagnosis of 331.0 (Alzheimer’s disease), 799.3 (debility), or 496 (COPD). CGS has sent out more than 3,920 ADRs for it, according to information CGS supplied to the National Association for Home Care & Hospice.
Home Health & Hospice Week
- HHAs:
Surprise! Here's Your Unannounced Survey
Watch out: New ‘extended surveys’ will dig deep into your business. In order to begin [...] - Compliance:
Get To Know Definitions For New Survey Terms
Four potential survey outcomes lay out the playing field. The 2013 Home Health Prospective Payment [...] - PPS 2013:
Get Ready: CMS Moves Forward With M1024 Changes
PPS 2013 clarifies and changes resolved condition reporting. Come Jan. 1, the way you [...] - Hospice Coding:
Bolster Hospice Claims With Thorough Coding
Could a hospice case mix adjustment system be in your future? Your hospice claims continue [...] - HIPAA Compliance:
Take 7 Steps To Protect PHI 'In The Cloud'
Choose your vendor carefully -- or risk leaks. If you’re like many other healthcare providers, you’re [...] - Breaching The Cloud:
Crucial Action Points You Must Follow
What are your responsibilities versus your BA’s? You have a lot of issues to consider [...] - Hospices:
Live Discharge Rates: Are You Making This One Mistake
Learn occurrence code 42 lessons from PEPPER reports. If you were unclear on how to use [...] - Medications:
What Is A Clinically Significant Medication Issue?
Check this list and examples to steer in the right direction. The Centers for Medicare [...] - Studies:
Check Out This Newly-Validated Fall Risk Assessment Tool
Look for a boost in your Home Health Compare scores. Have you been frustrated by the [...] - MAHC 10 - Fall Risk Assessment Tool
- Industry Note:
Why A Pending Settlement Could Expand Your Home Care Reimbursement
Court decision may impact how Medicare pays for patients who aren’t improving. You could have [...] - Industry Note:
NYC HHAs Must Pay Back Nearly $70 Million
NYC HHAs must pay back nearly $70 million in improper Medicaid claims reimbursed from 2007 [...] - Industry Note:
Kickbacks Conspiracy Yields Guilty Verdicts
Florida court convicted four individuals of kickbacks conspiracy charges related to home health services. A [...] - Industry Note:
Preventing Falls Tops Safety List For HHAs
Preventing falls is one of the measures stressed in this year’s National Patient Safety Goals [...] - Industry Note:
MAC Cracks Down On LUPA Threshold
Make sure your documentation for episodes that barely exceed the LUPA threshold will stand up [...] - Industry Note:
Concealing Medicaid Fraud Lands HHA Employee In Prison
A former HHA staffing manager is facing 10 months in prison for allegedly altering records [...] - Industry Note:
Walgreen Co. Plans To Target Hospice Providers
Walgreen Co. wants your pharmacy business, as the industry giant will launch a national platform [...] - Industry Note:
Physician Convicted Of Falsifying Plans Of Care For HHAs
Falsified plans of care got a Houston-area physician in trouble with the Department of Justice. [...] - Industry Note:
Missed ADR Deadlines Trigger Auto Denials
Make Additional Development Request deadlines or risk auto denials, as one Medicare Administrative Contractor is [...] - Industry Note:
New Tools To Secure PHI On Mobile Devices
Get expert help with protecting patient data on mobile devices, courtesy of the U.S. Department [...] - Industry Note:
Cancer Patients Need Earlier Hospice Referrals, Study Finds
Researchers call for earlier referrals for cancer patients, but payment policies are creating barriers to [...]
