Home Health & Hospice Week

Missing goals, measurements a common claim-killer.

Palmetto GBA and the other HHH MACs have a whole arsenal of reasons to deny or downcode your claims based on therapy. Here are the ones commonly cited in Palmetto’s recent probe edits covering nearly 7,000 claims:

5F080/5T080: Absence of Short and/or Long Term Goals within the Initial (PT/OT/ST as appropriate) Therapy Evaluation Documentation.

Specific “Granular” Denial Findings: In the initial physical therapy evaluation, the short term goal(s) and long term goal(s) were not stated in objective, measurable terms, and their expected date of accomplishment; the PT goals all have the same date of accomplishment.

5F301/5A301: Information Provided Does Not Support the Medical Necessity for Therapy.

Specific “Granular” Denial Findings: Initial therapy visit note not submitted; all therapy visit notes not submitted; missing specific functional goals for therapy in objective measurable terms; missing goals stated in objective, measurable terms signed by the certifying physician and with expected date(s) of accomplishment signed by the therapist.

5FTDR/5TTDR: Assessment, Measurement and Documentation of Therapy Effectiveness Not Submitted in the Medical Record.

Specific “Granular” Denial Findings: 30 day reassessment missing; assessment or reas-sessment completed by a therapy assistant; no credentials provided for person completing the initial assessment/30 day reassessment.

5CHG3: Medical Review HIPPS Code Change Due to Partial Denial of Therapy.

5F070/5T070: Visits/Supplies/DME Billed Not Documented/Not Documented As Used (often used for therapy visits).

5F072/5T072: No Physician’s Order for Services or More than Ordered.