The nationwide review of every home health agency’s face-to-face documentation has yielded a denial rate of 49.2%.
 
More than 25,000 claims were denied during the review from StrategicHealthSolutions LLC, the supplemental medical review contractor (SMRC).
 
Results of the review, posted recently on the SMRC’s website, doesn’t indicate how much money contractors are seeking to recoup.
 
The SMRC’s review involved a random sample of 52,223 claims with dates of service from July 1, 2011 through April 30, 2013. These episodes occurred prior to CMS eliminating the narrative requirements for face-to-face documentation.
 
The SMRC initially identified 1,396 claims that didn’t meet its project parameters.
 
Of the remaining claims, the SMRC denied 9,314 because agencies didn’t respond to additional documentation requests (ADRs). The ADRs requested that agencies send medical records within 45 days.
 
The SMRC denied 15,707 claims due to documentation issues, its website states.
 
As a result of its review, the SMRC recommends agencies review documentation prior to submitting it to “ensure that all medical record entries and orders are signed appropriately,” StrategicHealthSolutions’ website states. “For documentation with a missing or illegible signature, a signature log or signature attestation may also be submitted as part of the ADR response.”
 
StrategicHealthSolutions reviewed agencies’ claims “in the same manner” as Medicare administrative contractors would have, its website states.
 
 The SMRC’s review occurred as a result of an April 2014 report from the Office of Inspector General indicating CMS oversight of the face-to-face requirement for home health is “minimal” and that billions in payments shouldn’t have been made (HHL 4/21/14). CMS said that the review would lead to a consistent review process and less variable results.
 
Related link: View the SMRC’s review results at http://bit.ly/1FpJAmF.