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Home Health & Hospice Week

Industry Notes:

Intermediary Edit Denies 75% Of Long-Stay Hospice Claims

Published on Fri Feb 18, 2011

Make sure your documentation will hold up. Hospices that aren't documenting their long-stay hospice patients' terminal diagnoses carefully might as well say "good-bye" to their Medi-care reimbursement for them. Two ongoing edits of long-stay hospice patients' claims by regional home health intermediary Cahaba GBA have seen high denial rates, the RHHI says in its March newsletter for providers. Edit #1: Edit topic code 5037T targets claims with lengths of stay greater than 730 days, Cahaba explains in the Newsline. From October to December 2010, the edit saw a dollar denial rate of 69 percent, up from 53 percent a year ago. Edit #2: Edit topic code 5048T selects claims with lengths of stay of 999 days, and "had a near consistent denial rate of 74 percent over the last year, including last quarter," Cahaba says. For both edits, the top denial reason by an overwhelming margin was "the six-month [180 [...]
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