Home Health & Hospice Week

Home health agencies that furnish Part B outpatient therapy in the home may soon see therapy-related takebacks, thanks to the SMRC.

Supplemental Medical Review/Specialty Contractor Strategic Health Solutions recently completed a review of claims for outpatient therapy cap services just below the allowed therapy cap amount of $3,700, the SMRC says on its website.

The results: SHS denied 2,590 of the 7,080 claims reviewed (41 percent) because the SMRC didn’t receive supporting documentation for them within 45 days, the contractor says. SHS denied another 1,437 claims after reviewing them, to total a 57 percent error rate.

Reasons for the denials included lack of comprehensive evaluation and/or plan of care, identification of specific intervention/modality provided and billed, total timed code treatment minutes, and total time in minutes, SHS says. In addition, submitted medical records did not meet documentation requirements for supporting the number of units of therapy services billed, SHS adds.

Tip: Report the number of units for outpatient rehab services based on the documented procedure or service, SHS recommends in a “How to Prevent a Denial” section. “When reporting service units for procedure codes where the procedure is not defined by a specific timeframe (‘untimed’ procedure), the provider enters ‘1’ in the field labeled units. For untimed codes, units are reported based on the number of times the procedure is performed, as described in the procedure code definition (often once per day).”

Plus: “Several procedure codes used for therapy modalities, procedures, and tests and measurements specify that the direct (one on one) time spent in patient contact is 15 minutes.” SHS says. “Providers report procedure codes for services delivered on any single calendar day using procedure codes and the appropriate number of 15 minute units of service.”

HHH Medicare Administrative Contractor Palmetto GBA is sending overpayment demand letters based on the SMRC review, the MAC says on its website. The letters will include appeal information.

See the SHS article on the review at www.strategichs.com/wpcms/project-y1p5-medicare-part-b-outpatient-rehabilitation-therapy-services.