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Home Health & Hospice Week

Medical Review:

Wage War On Medical Necessity Denials With These 5 Steps

Published on Thu Jun 28, 2012

Know the rules when it comes to coverage, or lose your hard-earned reimbursement.Follow this expert advice to head off medical necessity denials:1. Read the manual. The Medicare Benefit Policy Manual (Pub 100-02) Chapter 7 is your Med-icare coverage bible, and you should know it practically by heart, experts agree. Consultant Lynda Laff with Laff & Associates in Hilton Head Island, S.C. also recommends reading the Medicare Claims Pro-cessing Manual (Pub 100-4) "to better understand the rules and criteria for billing." HHA billing is covered in Chapter 10 and hospice billing in Chapter 11. Links to the manuals are online at. www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs.html.2. Understand homebound doesn't equal automatic coverage. A patient must be homebound to qualify for the Medicare home care benefit, but that isn't the only requirement, cautions Chicago-based regulatory consultant Rebecca Friedman Zuber. "Many agencies don't understand that just because a patient has a chronic condition and is homebound, [...]
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