Home Health & Hospice Week
High-Therapy Claims Rack Up More Denials
Twenty-plus therapy visits are a red flag.
Face-to-face and OASIS problems continue to dog high-therapy claims, according to new medical review results released by one HHH Medicare Administrative Contractor.
Palmetto GBA reviewed 81 claims from June through August that included six HIPPS codes indicating 20-plus therapy visits — 5AGK*, 5CGK*, 5CHK*, 5BFK*, 5AFK*, and 5AHK*. Palmetto either partially or fully denied 36 of those claims — 44 percent, the MAC says on its website.
Other reasons for denials included not responding to ADRs, lack of medical necessity including for skilled observation, and exceeding the physician’s orders.
Palmetto deems all of these service-specific probes as “major risks,” it says. The MAC will continue all of the probe reviews for another quarter.
Home Health & Hospice Week
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