Home Health & Hospice Week

Face-to-face, plan of care and OASIS requirements continue to torpedo high-therapy claims in one Palmetto GBA edit.

Palmetto reviewed 10 claims with HIPPS code 5BHK* in Illinois, Louisiana and Mississippi in its latest edit targeting the HIPPS code that represents 20-plus therapy visits, a mid-clinical score (2) and the highest functional score (3). The Medicare Administrative Contractor either fully or partially denied four of the 10 claims. Of the total dollars reviewed ($8,541.11), Palmetto denied $4,463.50, resulting in a charge denial rate of 52.3 percent.

The top reason for denials, based on dollars, was plan of care/certification problems, Palmetto says. The number-two reason was face-to-face.

More issues: Palmetto also cites four in-stances of changing a HIPPS code because documentation didn’t support OASIS M0 items. Undocu-mented visits, homebound status problems, and single nurse visits also caused denials.