Home Health & Hospice Week
Note LCD Denial Change
You'll get a little Christmas present from HHH MAC subcontractor National Government Services this month. On Dec. 27, NGS will begin allowing providers to initiate their own adjustments to claims that have been fully or partially denied by automated edits for national coverage determinations (NCDs) or local coverage determinations (LCDs). NGS notes in an e-mail message to providers. Currently, providers have to submit a written request to NGS for the MAC to make the adjustments. Why? "Most claims that are denied for reason codes 55A00, 52NCD, 53NCD, or 54NCD involve a diagnosis that meets the requirements of the NCD or LCD and that is appropriately documented in the provider's records," NGS explains. "However, the diagnosis code has been omitted from the claim." The new process will improve efficiency, the MAC says. NGS will allow provider-initiated adjustment when a 55A00, 52NCD, 53NCD, or 54NCD claim or line item has been denied without medical review. "That is, no additional documentation request (ADR) was sent to you and no documentation was submitted," the MAC explains. Instructions: You should submit adjustments with claim change reason condition code D1, "changes to charges," NGS instructs. Enter the appropriate corrections to the diagnosis or other codes that resulted in the LCD/NCD denial, covered charges for the line item(s) involved, and adjustment reason code "LN" (Provider adjustment to correct LCD/NCD error).
Home Health & Hospice Week
- Medical Review:
Don't Let Top Denial Reasons Shoot Down Your Claims
Homebound status, lack of skilled need common reasons for denials. If you don't thoroughly understand -- [...] - OASIS:
Use Your OASIS To Pinpoint Medical Review Red Flags
Functional domain scores, diagnosis items can lead reviewers to your weak spots. One way to [...] - Tool:
Know When Your Patients Qualify For Home Care -- And When They Don't
Use this checklist from one HHH MAC to guide your eligibility assessments. Medical review from [...] - Compliance:
Hospices Serving Nursing Home Patients Brace For 2012 Scrutiny
OIG work plan for next year throws spotlight on this care setting. In a report [...] - Prospective Payment System:
Case Mix Changes Take Effect On M0090 Date
The 2.3 percent cut will hit a bit later. Don't expect to have an episode's [...] - Industry Note:
DME Bidding Areas Will Reach 100 By 2013
Bidding registration is now open. Chances are your patients' choice of durable medical equipment suppliers [...] - Industry Note:
Home Health Copay Threat Still Looms
Keep an eye peeled for developments in Washington regarding the so-called "doc fix." Industry members [...] - Industry Note:
Use New ABN Quick Glance Tool To Make ABN Calls
You've got newly revised instructions that go with the home health advance beneficiary notice (HHABN) [...] - Industry Note:
Make Hospice Discharge Code Change Jan. 1
Starting Jan. 1, you shouldn't use occurrence code 42 on your hospice claims when the [...] - Industry Note:
CMS Lifts One F2F Documentation Requirement
Ideally, you shouldn't be seeing any more claims denials when your hospitalized patient's documentation fails [...] - Industry Note:
MA Enrollees Increase
If you feel like your managed care headaches continue to grow, it's likely because Medicare [...] - Industry Note:
Home Health May Dodge Medicaid RACs' Scrutiny
The Medicaid RACs will soon make their debut. "Absent an exception, States will be required [...] - Industry Note:
Note LCD Denial Change
You'll get a little Christmas present from HHH MAC subcontractor National Government Services this month. [...] - Industry Note:
FBI Raids TX Agency
The fraud-fighting hammer appears to be dropping on an Alamo, Texas HHA. Rio Home Care [...] - Industry Note:
Newspaper Profile Gives Houston HHAs Bad Rap
Meanwhile, HHAs in Houston, Texas are getting a black eye in the press, thanks to [...]
