Hospices that aren't documenting their long-stay hospice patients' terminal diagnoses carefully might as well say "goodbye" to their Medicare reimbursement for them. Two ongoing edits of long-stay hospice patients' claims by Cahaba GBA have seen high denial rates, the carrier says in its March newsletter for providers. Edit #1:
Edit #2:
Edit topic code 5048T selects claims with lengths of stay of 999 days, and "had a near consistent denial rate of 74 percent over the last year, including last quarter," Cahaba says.For both edits, the top denial reason by an overwhelming margin was "the six-month [180 days] terminal prognosis not being supported in the documentation," Cahaba says.