The rules did not change, but there has been a recent increase in Pre-Claim Review (PCR) non-affirmations when wound measurements and other clinical documentation is not submitted. In order for the wound care to be considered reasonable and necessary, the Medicare Benefit Policy Manual Chapter 7 – 40.1.2.8 Wound Care states, “the size, depth, nature…
Tag: medicare
Hospice Certification
As scrutiny of hospice organizations increase, it’s particularly important for hospices to ensure their certifications and recertifications of terminal illness meet all required elements. In the 2021 Medicare FFS Supplemental Improper Payment Data report of improper payments, the top cause for error was “insufficient documentation of the physician’s certification/recertification”. A few short months from now,…
Hospice Benefit Eligibility
Just last month, the Office of Inspector General (OIG) announced its intent to perform a nationwide review of hospice beneficiary eligibility. This action was in response to identified recent negative findings during individual provider audits by the Office of Audit Services. In their audits, they found a pattern of patients who did not meet eligibility…
