Eli's Hospice Insider

Published on Tue Dec 11, 2012 PDF

MAC targets claims for long-stay hospice patients.

Don’t be late in responding to additional development requests, or you could be very sorry.

That’s the message from HHH Medicare Administrative Contractor CGS, which reminds providers that they have 30 days to submit their ADR responses. "If documentation is not mailed within the 30-day request, it may begin to auto-deny unnecessarily," the MAC warns on its website.

This is a pertinent issue for hospices, who have been on the receiving end of multiple widespread edits lately. CGS lists six hospice widespread edits on its website at www.cgsmedicare.com/hhh/medreview/med_review_edits.html, compared to just two edit topics for home health agencies.

The edit generating the most ADRs is 5101T, which selects claims with a length of stay greater than 180 days and a primary diagnosis of 331.0 (Alzheimer’s disease), 799.3 (debility), or 496 (COPD). CGS has sent out more than 3,920 ADRs for it, according to information CGS supplied to the National Association for Home Care & Hospice.

Resource: For information on CGS edits of long-stay hospice patients and tips for documenting terminal illness for patients with slow-declining diagnoses, see Eli’s Hospice Insider, Vol. 5, No. 6.