Home Health & Hospice Week

Expect scrutiny for claims with dementia as the primary diagnosis. Denials for terminal illness-related problems are topping the charts for hospices, but you can sidestep such landmines with strengthened charting and coding. About 40 percent of hospice claims denied are due to documentation failing to support the terminal illness, explained Latesha Walker with the Centers for Medicare & Medicaid Services at the National Association for Home Care & Hospice's annual March on Washington conference. And 39 percent of hospice claims denied are due to the diagnosis code not supporting the terminal illness, said Walker, director of CMS's Division of Medical Review and Education. Medical reviewers are also finding problems with the hospice face-to-face requirement, Walker noted in the March 26 panel. And reviewers are seeing deficiencies with the physician narrative required for certification and recert, Walker added. Problems range from the technical (lacking a date or signature) to the clinical [...]