Agenda

During this session home health veterans will come together to answer your questions about the current state of Medicare home health claim reviews. They will provide an overview of the recent enforcement efforts such as the probe-and-educate review, pre-claims review demonstration, face-to-face (F2F) denials enforcement and more. Plus, get an update on the ALJ backlog and other trends that agencies need to be aware of to secure steady cash flow.

Early data from the probe-and-educate review revealed that a whopping 90% of claims were being denied. Get an inside look from one MAC regarding the most common agency mistakes are resulting in ADRs and denials. You will learn how to respond to ADRs, include visit notes and discharge summaries that meet MAC guidelines, capture physician signatures needed to pass muster, face-to-face guidelines and therapy documentation requirements.

The Medicare coverage guidelines are a moving target. Not only are they open for interpretation, but they are also ever-changing. During this session, you will get a rundown of the latest coverage guideline changes that have the biggest impact on claims processing to ensure you get paid quickly and correctly. Get examples of denial-proof documentation related to homebound status, medical necessity, skilled care and ICD-10. Plus, put processes in place for auditing claims before submission to ensure that you get paid the first time, every time.

Therapy cases are some of the most profitable, but also the most scrutinized. Some of the most common denials during the MAC probe-and-educate review occurred because agencies aren’t providing the detail necessary to show patients’ therapy goals. And per a recently-updated Palmetto LCD, now agencies only need to list short AND/OR long-term goals. Regardless, therapists still need to learn how to properly document how they expect the patient to improve and what progress the patient is making, or they risk auditor scrutiny and claim denials.