The NHIC,
CORP is the home health MAC for the New England Region of the United
States. They published the results of
their three home health prepay edits for the period of July 1, 2012 to December
31, 2012. The edits are listed below:
5AC01-
billing of the home health resources groups (HHRGs) 3AFK*
5AC02-
Billing the HHRG 1AFK*
5AC03-billing
5-7 visits for full episode payments
They issued
4,785 Additional Documentation Request (ADR) for the three edits. Nine percent of the claims were denied
because the home health agencies did not provide the medical records within the
required time frame. Approximately 48%
of the reviewed claims were paid in full and 52% received denials. The denial breakdown is listed below:
56% –
Skilled observation was not reasonable and necessary
15% – no
physician certification
14% – no
support for the homebound status
5% – physician
orders were not signed timely
5% – OASIS
not documented
5% -
Therapy services were determined not to require a therapist
For more
information please utilize the following link.
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