Tag: home health

State Operations Manual (SOM) Appendix B Revisions

On March 15, 2024, CMS released Memorandum QSO-24-07-HHA. The memorandum summarizes changes made to State Operations Manual (SOM) Appendix B – Guidance for Surveyors: Home Health Agencies based on final rules which have amended home health conditions of participation. Key changes include:

Medical Necessity

One of the most common reasons for home health claims denials revolve around medical necessity for skilled nursing services—denial code 5HN18.  During the first quarter of 2021, the Medicare Administrative Contractors identified this denial reason among the top five.  The solution boils down to a good understanding of skilled nursing services and documentation, documentation, documentation. …

Additional Document Requests

Additional Document Requests (ADRs) strike fear into the hearts of most home health and hospice providers.  One of the leading reasons for claim denial results from providers not responding to ADRs.  That, in itself, will lead to more scrutiny.  Providers need to ensure they have a clear cut ADR process including prompt identification of the…

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…