Eli's Hospice Insider

Focus on 6-month prognosis, MAC urges.

Be sure your claims for hospice patients with two nutrition conditions are up to snuff, because one Medicare Administrative Contractor is taking a closer look at them.

“Our Medical Review Department will be initiating a widespread prepayment review of claims for increased use of diagnosis group 262 and 263,” HHH MAC National Government Services says in a recent message to providers. DX group 262 is “Other severe protein-calorie malnutrition” and DX group 263 is “Other and unspecified protein-calorie malnutrition.”

The records supporting the claims must support a six-month prognosis, NGS notes. Documentation must include a notice of election/signed election statement by the beneficiary; recertification evaluation(s); initial and all subsequent physician’s certifications; nurses notes, initial assessment and if applicable, complete general inpatient medical records; physician progress notes and orders; all other caregiver notes, including interdisciplinary group notes; and documentation to support the face-to-face encounter, NGS reminds hospice providers.