Home Health & Hospice Week

Routine social worker evaluations can torpedo your claims. Sole nursing visit denials may be more common, but sole medical social worker visit problems can cost you a pretty penny too when they result in LUPAs. Medical reviewers for regional home health intermediary Cahaba GBA denied 76 percent of claims with one MSW visit making up one of five visits on the claim, Cahaba says in its March newsletter for providers (see related story, p. 82). The Medicare Benefit Policy Manual says MSW visits may be covered if "the services of these professionals are necessary to resolve social or emotional problems that are, or expected to be an impediment to the effective treatment of the patient's medical condition" and "the plan of care indicates how the services which are required necessitate the skills of a qualified social worker ... to be performed safely and effectively," Cahaba explains. Pitfall: "Routine evaluations for [...]