Home Health & Hospice Week

Medical necessity can be hard to prove for hypertension patients. If you're treating a patient for hypertension in her third or later episode, your documentation must be superlative or you'll risk your Medicare payment. HHH Medicare Administrative Contractor CGS has been conducting a widespread edit of claims with hypertension as the primary diagnosis and length of stay greater than two episodes, the MAC notes on its website. In the last quarter, CGS denied a whopping 97 percent of the claims reviewed under this edit. That's up from an 88 percent denial rate a year ago, the MAC points out. This has been an ongoing problem for home health agencies, experts say. "I am not in the least surprised at the denial rate for the hypertension recertifications," says clinical consultant Pam Warmack with Clinic Connections in Ruston, La. The problem: The top denial reason under the edit "is related to documentation [...]