Home Health & Hospice Week

To stay off medical reviewers' radars, steer clear of these two problems for home health agencies and hospices: high therapy use and elevated hospice care levels.

High therapy utilization for home health agencies is a problem medical reviewers are seeing, said Latesha Walker with the Centers for Medicare & Medicaid Services, at the National Association for Home Care & Hospice's annual March on Washington conference. Claims targeted for high therapy use will often have problems such as failing to show a prior level of function, missing or insufficient documentation, and errors in orders, Walker told attendees at a March 28 session.

On the hospice side, reviewers are targeting claims with long lengths of stay for the General Inpatient (GIP) level of care, Walker revealed. Claims for patients with long GIP stays who have diagnoses like dementia, failure to thrive, and debility often fail to have adequate documentation to support the level of care, Walker said. They can also lack the documentation to justify even regular hospice care.

"Make sure the picture is being painted" for the level of hospice care received, Walker urged attendees. That includes key clinical items.