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tci Part B Insider - 2013 Issue 23

Physician Note: This MAC Denied 31 Percent of Hospice Claims

Plus: Don’t attempt to adjust redetermined claims. Make sure your physician’s terminal illness documentation is up to snuff for hospice claims, or you may lose your rightful reimbursement. In a recent probe, Medicare Administrative Contractor NHIC conducted probes of hospice claims in their first, second, and third benefit periods. Reviewers denied 31 percent of claims for the first and second period, and 27 percent of claims in the third period. Results: Lack of valid physician certification was the top denial reason (43 percent) for first period claims, timely physician cert/recert was second(20 percent), and terminal prognosis was...

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