Home Health & Hospice Week
Face-To-Face Problems Lead To Denial Rate Of 55% In Recent Review
Palmetto GBA continues to shoot down claims billing for 20 or more therapy visits. The MAC revealed the results of two recent reviews of HIPPS codes indicating the highest therapy level — 5BHK* and 5CHK*.
Palmetto reviewers denied, either partially or in full, 26 of the 47 5CHK* claims reviewed in the third quarter, a denial rate of 55 percent. The MAC denied $28,473.11 of the $70,601.34 reviewed, a 40 percent denial rate. The top culprit was face-to-face problems in 41 percent of dollars denied. The second-highest reason was non-submission of records, the MAC notes on its website.
For 5BHK, reviewers denied 4 of 10 claims reviewed (40 percent). They denied $8,367.63 of the $20,044.43 reviewed (42 percent). This time, F2F and non-submission of records were nearly equal as denial reasons (49 percent and 51 percent, respectively), Palmetto reports.
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