Poor Documentation Crippling Providers With Medicare Denials, Expert Notes

April 27, 2017, Elizabeth Leis Newman, McKnight's Long-Term Care News - Untimely certifications, missed or incorrectly billed Change of Therapy documentation, or a lack of documentation supporting a signed physician order for skilled therapy are among the top reasons Medicare claims denials are hitting facilities, an expert said Wednesday.

In one review of Prepayment RH (high rehabilitation) categories in six months from 2016, Noridian Healthcare Solutions found that out of 75 claims, nearly half were either partially or totally denied, said Marcum Senior Manager of Advisory Services Marilyn Mines, RN, BC, RAC-CT.

She shared an example of how such a denial occurs with attendees at the LeadingAge Illinois annual meeting, which is taking place this week at Navy Pier in Chicago.

“A facility wanted me to help appeal a denial, and I said, ‘Send me the documentation,'” she said, noting that she always wants a facility to be paid for its work. Sadly, “For two weeks that they were denied, the therapy notes said exactly the same thing in the progress notes. No progress had been made; there was no change in a plan of treatment. I said, ‘How can you appeal something where your staff documented no progress?'”

With Change of Therapy documentation, “If we have a Medicare meeting, and have the MDS and therapy people talk, we can avoid some of these problems.”

Other reasons for claims denial ........ CLICK HERE TO READ MORE