Home Health & Hospice Week

HHH Medicare Administrative Contractor denies more than half of HH claims reviewed.

Medical review results continue to show how impossible Medicare’s face-to-face documentation requirements are.

HHH Medicare Administrative Contractor Palmetto GBA recently reviewed 1,218 claims with the HIPPS code 1BGPx, which represents a HHRG of C2F2S5 — an early episode with 11 to 13 therapy visits and a moderate clinical need. Palmetto denied over half the claims, the MAC says in a new article on its website.

Even though the prepay review targeted therapy claims, Palmetto made 74 percent of the 635 claims denials based on face-to-face physician encounter reasons, it says. The review covered claims processed from November 2013 to January 2014.