Home Health & Hospice Week

Documentation that doesn’t support the OASIS M0 items chosen is climbing the charts when it comes to reasons for claims denials. Results from five recent Palmetto GBA edits showed that denial code 5CHG1, which indicates “Medical Review HIPPS Code Change/Documentation Contradicts MO Item(s),” was the top reason in nearly all of the edit results for give different HIPPS codes including high therapy (20+ visits).

Face-to-face denial reasons often ran a close second, though, the HHH Medicare Administrative Contractor shows in denial stats posted to its website. 

Keep in mind: “The number one reason for denial is still by far overall due to FTF,” points out billing expert M. Aaron Little with BKD in Spring-field, Mo. This “small cross-section” of claims that have 20 or more therapy visits billed is more likely to see HIPPS code contradiction denials due to those therapy services.

The service-specific pre-pay probe medical reviews focused on HIPPS codes 5CHK*, 5AGK*, 5BFK*, 5AFK*, 5AHK*, and CGK*.