Eli's Rehab Report
Know the Codes Palmetto Is Targeting
PDF
HHH Medicare Administrative Contractor Palmetto GBA targeted claims with 2CGK* and 1BGP* HIPPS codes, reviewing more than 3,800 of them from the May-to-June timeframe, it notes in a new article on its website. It denied, either fully or partially, nearly 2,300 of them — nearly two-thirds of the claims reviewed.
A 2CGK is a patient with a Home Health Resource Group (HHRG) of C3F2S1, explains consultant Pam Warmack with Clinic Connections in Ruston, La. It is an early episode of care (1st or 2nd episode) who is receiving 14 to 15 therapy visits. “The C3 represents a higher level of clinical need and the F2 means moderate functional needs,” Warmack says in reference to the PPS grouper domains.
The 1BGP represents a HHRG of C2F2S5, Warmack continues. “This is also an early episode of care with 11 to 13 therapy visits provided,” she tells Eli. “The difference here is the clinical domain represents only moderate clinical needs.”
The claims in these codes don’t seem to have much in common except high therapy, experts agree.
Eli's Rehab Report
- Outpatient Outlook:
How to Juggle Extra Evals in Your Functional Limitation Reporting
You can now report a separate evaluation on a progress report day. As the new [...] - Practice Pointers:
Sharpen Your Staffing Knowledge of Contract Therapists and Agencies
Remember: There’s more than one way to contract a therapist. Staffing your therapy team is [...] - MDS 3.0:
CMS Releases Corrections on Key Parts of Revised RAI Manual
Look for updates on therapy date counting and the ADL Algorithm. Before you’ve had time [...] - Home Health Therapy Documentation:
Avoid HIPPS And F2F Denials With Airtight Documentation
Therapy-targeted medical review can land you in hot water. You need to check that the [...] - Reader Question:
Follow These 8 Key Items To Code A Short SNF Stay For Rehab
Question: I did an MDS as a short stay but the RUG category came up [...] - Business Strategies:
Talk Business With Your Payers -- and Strike Hidden Gold
Tip: Try renegotiating a contract before you cancel it. Do you think that your payers’ [...] - Billing:
Know the Codes Palmetto Is Targeting
HHH Medicare Administrative Contractor Palmetto GBA targeted claims with 2CGK* and 1BGP* HIPPS codes, reviewing [...]