Home Health & Hospice Week

Tip: Your physicians are a critical tool.

Certification errors are topping the list for hospices' claims denials (see related story, p. 265). Consultant Beth Carpenter with Beth Carpenter and Associates in Barrington, Ill., offers this advice to reduce cert-related denials:

1. Educate. Implement in-depth orientation and annual inservices for medical directors and physician designees, Carpenter counsels. The training should cover appropriately documenting the certification narrative.

2. Go by the book. Supply medical directors and physician designees with Local Coverage Determinations (LCDs), Carpenter adds. The policies spell out what is required in documentation.

Resource: You can access each HHH Medicare Administrative Contractor's LCDs on its website at www.cgsmedicare.com/hhh/coverage/Coverage_Guidelines/LCD.html for CGS, www.ngsmedicare.com/wps/portal/ngsmedicare/mpc for Na-tional Government Services, and www.palmettogba.com/medicare for Palmetto GBA -- select "J11 MAC -- Home Health and Hospice" in the left column, then click on "Medical Policies" in the left column and choose "LCDs and NCDs" from the drop-down menu.

3. Police yourself. Find your mistakes before reviewers do -- while you can still fix many errors and receive your rightful reimbursement in a timely manner. Audit 100 percent of all certifications and recertifications, as well as all face-to-face documentation, Carpenter urges.

4. Use your docs. Finding that you're hitting a brick wall when it comes to persuading certain referral sources to beef up their documentation? Turn to a critical resource for help -- your own physician advocates. "Ask the medical directors, physician designees and team physicians to perform peer review," Carpenter recommends