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Home Health RCD Top 5 Non-Affirmation and Claim Denial Reasons

Review Choice Demonstration (RCD) did not add any new requirements, but home health agencies are still struggling with the Face-to-Face (F2F) and getting an affirmation. Agencies need to remember that the F2F documentation must be “related” to the primary diagnosis (the primary reason for home care) and must be timely. This means that the encounter…

Review Choice Demonstration (RCD) did not add any new requirements, but home health agencies are still struggling with the Face-to-Face (F2F) and getting an affirmation. Agencies need to remember that the F2F documentation must be “related” to the primary diagnosis (the primary reason for home care) and must be timely. This means that the encounter must have occurred within 90 days prior to the start of care or within 30 days after and that primary diagnosis needs to be addressed in the provider’s assessment of the patient. Also remember that If the F2F encounter is not performed by the certifying provider, the date of the encounter must be documented by the certifying provider or the certification is not valid. To ensure compliance, make sure you have a process in place to check F2F documentation during the intake and/or admission and obtain the documentation early or get the encounter scheduled as soon as possible. If the certifying provider needs to acknowledge the date of the encounter by another provider, have a process to make this a part of your plan of care or writing a supplemental order. Making a few minor process changes can increase your chance of success with RCD.

See Palmetto GBA Home Health RCD Top 5 Non-Affirmation and Claim Denial Reasons Chart Here