On November 1, CMS released the CY 2025 Home Health Payment Final Rule. It includes a permanent adjustment of -1.975% to the base payment rate, which is half the total required adjustment (-3.95%) to counter expected PDGM-related behavior adjustment. The… Read More »In Summary: CY 2025 Home Health Payment Final Rule
Claims containing primary diagnoses that do not fall into one of the 12 PDGM clinical groups may be denied by CMS or sent back to the agency with a “Return to Provider” (RTP) remark. Such primary diagnoses are referred to… Read More »Tips to Avoid the Use of Questionable Encounter Codes
CMS released the CY 2024 home health final payment rule last November 1. CMS estimates that Medicare payments to HHAs in CY 2024 will increase in the aggregate by 0.8 percent, or $140 million, compared to CY 2023. The final… Read More »In Summary: CY 2024 Home Health Final Payment Rule
F2F encounters are essential for certifying a patient’s eligibility for Medicare home health benefits. However, complying with F2F documentation requirements has persistently challenged many home health agencies, resulting in frequent Medicare claim denials. F2F guidelines may appear ambiguous making it… Read More »Revisiting the Basics of F2F Compliance
Diagnosis/coding queries are helpful to ensure proper documentation and accurate coding, but getting timely responses from physicians is often challenging. Physicians’ busy schedules make it hard to find a suitable time for discussions. Some may resist or cooperate less when… Read More »Coding Query: Tips and Examples
In certain cases, the ICD-10-CM guidelines require the use of multiple diagnosis codes to report a specific medical condition. This practice goes by various names such as “mandatory multiple coding,” “dual classification,” “dual coding,” or “mandatory dual coding.” An example… Read More »Understanding Etiology and Manifestation Coding
Home health agencies greatly benefit from being aware of the top reasons for claims denials by MACs. It helps save valuable time and resources in rectifying denied claims and reduces the likelihood of receiving Additional Development Requests (ADRs) from CMS,… Read More »Top Claims Denial Reasons from MACs
Thorough clinical documentation is crucial for determining eligibility for home health services, ensuring accurate coding assignment, maintaining regulatory compliance, and supporting claims. Incomplete documentation with missing key information can lead to a chain of issues. Beyond knowing the fundamental coding… Read More »Common Documentation Gaps in Specific Code Categories
MACs have reported that one of the top five reasons for claim denial is invalid physician certification, particularly when the necessary face-to-face (F2F) encounter was missing, incomplete, or untimely. To receive payment, SOC certification must include F2F encounter documentation that… Read More »Obtain Complete F2F Documentation with 4 Useful Tips
Coding has become an increasingly important and complex task for home health agencies. There have been recent updates to the guidelines related to the Face-to-Face Encounter and its relevance in primary diagnosis coding, further emphasizing the need for accurate and… Read More »Top FAQs on F2F Encounter Documentation
