Stop risking reimbursement by understanding coverage rules and properly training and supervising staff.With reviewers examining medical necessity more closely than ever, you need to heed what the experts have to say on fending off denials: 1. Read the manual. The Medicare Benefit Policy Manual (Pub 100-02) Chapter 7 is your Medicare 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 Processing Manual (Pub 100-4) "to better understand the rules and criteria for billing." Home Health Agency 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 [...]