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Home Health & Hospice Week

Industry Notes:

Edit Shoots Down Nearly All Hypertension Claims

Published on Tue Aug 03, 2010

COPD claims also see high denial rate. If you're submitting claims for long-stay patients with chronic diseases, you'd better work on your documentation for them. That's because two edits at regional home health intermediary Cahaba GBA that focus on COPD and hypertension patients have seen sky-high denial rates. Edit No. 1, 5THBX, reviews claims with a length of stay greater than 120 days and primary diagnosis of 496.xx, indicating COPD. The denial rate for the edit is a whopping 85 percent, Cahaba says in its September newsletter for providers. Edit No. 2, 5023T, targets claims with a length of stay greater than 120 days, a primary diagnosis of 401.9 indicating hypertension, and five to nine nursing visits. The edit's denial rate is an even higher 98 percent. The chief reason for denials for both edits is "5HMED: Documentation does not support medical necessity of services billed," Cahaba notes. "Although the [...]
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