In December 2023, Performant, the designated Recovery Audit Contractor (RAC) for the Centers for Medicare and Medicaid Services (CMS), introduced a new issue, Issue 0221 – Hospice Care: Extended Length of Stay: Medical Necessity and Documentation Requirements, to its approved list. This newly added issue centers on evaluating the “Extended Length of Stay” to verify medical…
Tag: documentation
Homebound Status
The inability to leave home—homebound status–for patients receiving home health care services has plagued agencies since its inception. It has been the source of many heated discussions in team meetings, has it not? Initial assessments of patients typically start out strong with reasons the patient is unable to leave his or her home without a…
Allowed Practitioners
In June, CMS made a clarification to a previous transmittal which allows clinical nurse specialists, physician assistants, and nurse practitioners to certify eligibility and order services under the Medicare home health benefit. These individuals, of course, are defined as allowed practitioners. The CMS Transmittal 11447 replaced Transmittal 11386 (previously released in April 2022) and stated…
Approved Signatures
Services and orders provided for home health and hospice require some kind of authenticating signature by the author. In this age of electronic medical records, organizations are faced with a variety of signatures–handwritten and electronic. It’s often difficult to determine what is acceptable to the Medicare Administrative Contractors (MACs). Here are a few tips. First…
Medical Necessity
One of the most common reasons for home health claims denials revolve around medical necessity for skilled nursing services—denial code 5HN18. During the first quarter of 2021, the Medicare Administrative Contractors identified this denial reason among the top five. The solution boils down to a good understanding of skilled nursing services and documentation, documentation, documentation. …
