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Home Health & Hospice Week

Medical Review:

Intermediary Denies 88% Of These 5-Visit Episodes

Published on Fri Feb 12, 2010

Defend against scrutiny of single nursing or social worker visits with 5 tips. If you're furnishing episodes that skirt the LUPA line, you'd better brush up on your Medicare coverage basics or face denials. That's what home health agencies whose claims fell into two edits from regional home health intermediary Cahaba GBA have found out the hard way. Cahaba has two widespread edits in place for episodes with five visits -- one for claims containing one skilled nursing visit and four therapy visits,and one for claims containing a single medical social worker (MSW) visit. In the latest period, Cahaba medical reviewers denied 88 percent of the claims with one nursing visit and four visits of any kind of therapy. And they denied 76 percent of claims with one MSW visit making up one of the five visits, Cahaba says in its March newsletter for providers. For the nursing-therapy claims, "the top [...]
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