Eli's Hospice Insider
RHHI Gets Tough With Hospice Cancer Claims
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Reviewers shoot down claims for certification, terminal prognosis problems.
Regional home health intermediary Cahaba GBA is launching a widespread review of hospice claims with diagnoses of 202.xx (Other malignant neoplasms of lymphoid and histiocytic tissue) and 203.xx (Multiple myeloma) and with lengths of stay greater than 180 days.
In a probe review, Cahaba reviewers shot down most claims due to "missing, incomplete, or untimely certifications and the six-month terminal prognosis not being supported in the medical record," the intermediary said in its March newsletter to providers.
Tip #1: The cert period dates must be clearly identified on the form,Cahaba instructed. "Simply having the statement 'third benefit period' is not enough to be able to tell which certification period the physician is signing," it said.
Tip #2: Don't rely on your diagnosis codes to show why hospice is appropriate for the patient, Cahaba warned. Your documentation should "paint the picture."
Tool: To boost your documentation, make use of Cahaba's hospice documentationchecklist at www.cahabagba.com/rhhi/education/materials/quick_hospice_doc.pdf.
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