Home Health & Hospice Week

Homebound status, lack of skilled need common reasons for denials. If you don't thoroughly understand -- and document -- a patient's homebound status and skilled need, you could wind up furnishing her care for free. In the third quarter of 2011, Palmetto GBA's number-one denial reason for home health agencies was "5AT10/5FT10 -- Documentation Does Not Support Homebound Status," the HHH Medicare Administrative Contractor reports in its December provider newsletter. "The services billed were not covered because the medical records submitted for review did not support homebound status," the MAC explains. And the number-three denial reason was "5A041/5F041 -- Information Provided Does Not Support the Medical Necessity for All or Part of This Service," Palmetto adds. "The clinical documentation submitted for review did not support the medical necessity of the skilled services billed," the MAC details. For example: "The submitted documentation may have indicated there was no longer a reasonable potential for change in [...]