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Home Health & Hospice Week

Hospice:

Beware Claims Denials For OBS Hospice Patients

Published on Wed Nov 16, 2011

Other claims getting caught up in edits include those for nursing home patients, vascular lymphoma, and cardiomyopathy. If your patient has a primary diagnosis of organic brain syndrome (294.8) and a length of stay exceeding 240 days, you'll be waving a big red flag to medical reviewers. Home Health & Hospice Medicare Administrative Contractor CGS recently released results of a widespread edit of such claims during the July 1 to Sept. 30 period. The edit racked up a 64 percent denial rate, the MAC reports in its Decembernewsletter for providers. The top denial reason for the edit was 5PTER, "Six-month terminal prognosis not supported," CGS reveals. "Patients with OBS ... may be appropriate for hospice, but it is the hospice agency's responsibility to ensure the documentation supports the six month prognosis," the MAC exhorts. The 5PTER denial "is related to the common obstacle of documenting a six-month terminal prognosis," CGS [...]
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