Home Health & Hospice Week

New edits and probes continue to hit home health and hospice providers nationwide. For example, MACs Palmetto GBA and CGS recently announced new hospice edits based on location (SNFs), length of stay and diagnoses (see Eli’s HCW, Vol. XXII, No. 39).

Do this: "Hospices should check the FISS system, ideally on a daily basis but not less than weekly, for any claims in the S B6001 status that indicates there is an additional development request (ADR) on the claim," advises the National Asso-ciation for Home Care & Hospice. "If there is an ADR, hospices must respond no later than 30 days after the request date," the trade group urges. Any denials can be appealed within 120 days.

"It is important that providers respond to ADRs in a complete and timely manner in order to avoid claims processing delays, which could affect your reimbursement," directs MAC National Government Services in a message to providers. "It is important that the provider’s responsible person who handles these ADRs understands the importance of responding to these requests to ensure the ADRs are submitted in a timely fashion."

Tip: "Each response need not be sent separately," NGS says. "It is acceptable to send multiple responses in a single mailing as long each is individually bundled with a copy of the corresponding ADR within the mailing."

Providers can mail or fax their responses, NAHC notes. NGS recommends using U.S. mail.

Important: "Include all records necessary to support the services for the dates requested," NGS stresses. For a free link to NGS’s article, which includes step-by-step instructions on how to view your ADRs in FISS, e-mail editor Rebecca Johnson at rebeccaj@eliresearch.com with "NGS ADR Link" in the subject line.