Hospice providers subject to increased pre-payment review are struggling with patient prognosis, according to Palmetto GBA, the Medicare Administrative Contractor responsible for reviews in Arizona, California, Nevada and Texas.
 
A recent update from Palmetto noted a 21% denial rate for claim reviews in the last three months of 2024.
 
Of the claims denied, half were due to documentation not supporting the prognosis of six months or less.
 
Palmetto’s tips on how to avoid this denial include ensuring a legible signature is present on all documentation necessary to support the six-month prognosis, as well as carefully reviewing Local Coverage Determinations.
 
Other top reasons for denials included:
  • The Hospice Election Statement doesn’t meet statutory or regulatory requirements
  • Face-to-face encounter requirements not met
  • No plan of care
  • Physician narrative statement not present or not valid
See the full Palmetto report at https://tinyurl.com/ypajkpxt.