tci Medicare Compliance & Reimbursement - 2019 Issue 12

Industry Note: MAC Cautions Physicians About Medical Necessity for Home Health

When referring Medicare beneficiaries for home health care, it’s all in the details. In a recent release, one Medicare Administrative Contractor (MAC) reminds physicians of their substantial referral responsibilities, but also may be scaring them out of making referrals at all. HHH MAC Palmetto GBA walks physicians and referring medical facilities through the documentation requirements for patients referred to home health agencies in a recent article on its website titled “Home Health Referrals.” The description ranges from homebound status to intermittent skilled services to face-to-face documentation. But: The article also contains this bold-face warning to docs:...

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