decisionhealth Newsletters, Part B News - 2015 Issue 2 (February)
Look to patient status, medical necessity to avoid denials of home service codes
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Article Overview
This article reviews Medicare denial trends for home service evaluation and management codes and explains why patient status and documentation of medical necessity matter. It is intended for coders, billers, and practice staff who work with home visit claims and want to understand the general factors associated with denials and reimbursement risk.
Why This Topic Matters
Home visit claims can be vulnerable to denials, and misunderstandings about patient status or incomplete documentation can affect payment outcomes. Understanding the broad denial patterns discussed in the article can help revenue cycle staff identify claim areas that deserve closer attention.
What You Will Learn
- How Medicare denial trends can affect home visit evaluation and management claims.
- Why patient status is a key consideration for home service billing.
- Why documentation of medical necessity is important in home visit claims.
- What types of claim patterns are associated with higher denial exposure.
Who Should Read This
- Medical coders
- Medical billers
- Revenue cycle staff
- Practice managers
- Physician office staff
Codes Discussed
Code Ranges Discussed
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