Over the last couple of years ZPICs and RACs have reviewed and denied home health claims from various patients. Their denial may claim that the patient is not home bound and is not qualified for home health services. Have you received one of those denials? If you believe the patient was homebound have you filed an appeal? Some home health providers have just rolled over and accepted the denial, meaning they lose the reimbursement for the claim, but what about the patient. Has your failure to appeal the denial flagged the patient as not home bound for other home health agencies? I know this has happened because some of my clients have tried to admit some of these patients after they were denied for not being home bound in the past. Their claims were also denied, because the MAC stated they had been previously determined as not being home bound. This could be for a patient that may have recently been a patient of a previous home health agency or it could be many months since that patient was receiving home health services.
The failure of the previous home health agency to appeal the denied claim has now placed a red flag on the patient's record and restricted their ability to receive home health services in the future. My advice to all my clients and seminar attendees is to appeal denials. I am not suggesting that a home health agency or hospice admit a patient that is not qualified. You should only admit patients who qualify and need your services. If it were my home health agency or hospice and a RAC, ZPIC, CERT or MAC denies a claim, they better bring their lunch and dinner. If I believed the patient was qualified, I would appeal the claim to every level. I realize the appeals are costly and I would do everything I could to reduce the potential cost of the appeal, but I would appeal all of the claim denials. If my appeal failed at the first level, I would continue to appeal the denial all the way to the highest level. I would not only be advocating for my company I would also be advocating for the patient. I think most of us would agree that health care providers, physicians and suppliers are now considered guilty until proven innocent. I agree that all of the bad actors in the health care area should be removed from the business, but viewing all health care providers, physicians and suppliers as bad actors is wrong. This must change. You should advocate for your business and your patients. It is starting to make a difference in ALJ Level because appeals by law that should be heard within 90 day are now taking over 2 years. Keep their feet to the fire! We have Robert Liles speaking at our Home Health, Hospice, Private Duty, and Physician Practice seminars in Las Vegas in late January and early February next year. He is the best healthcare attorney I know dealing with ZPIC, RAC, CERT, and MAC denials. He will be speaking on "Preparing and Responding to Various Medicare Claim Audits", "Compliance Plans (Your First Level of Defense)", "Latest Employment Law Issues", and "HIPAA and Other Privacy Issues". There is more information about the seminar below.
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Dixon Healthcare Solutions, Inc. Next Destination Seminars
Exploring Trends &
Routes for Success
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Four Great Seminars presented by
Dixon Healthcare Solutions, Inc.
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Brochures
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Location is the Monte Carlo in Fabulous
Las Vegas, NV
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Registrations Forms
It is important to register early, because the rates go up as the date gets closer and their is limited seating.
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The speakers include:
Richard Dixon,
J-non Griffin
Robert Liles
Richard Martin
Cheri Martin
Robert Floyd
Donna Floyd
Adam Bird (Physician Practice Only)
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Program Outlines
The program is great for each and we hope to see you in Las Vegas at the Monte Carlo
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