The risk of Medicare claim rejections for incorrect principal ICD-9 codes remains high. How many rejections will your organization experience this fall? Hint any number above zero is pure waste. Palmetto GBA has analyzed hospice paid claims data in AB MAC Jurisdiction 11 through the first quarter of 2014 and determined that while some hospice providers have already taken action to prevent these coding errors, others have not.  

As of October 1, 2014, Medicare hospice and palliative care claims will be “returned to the provider” (RTP) for errors in the principal diagnosis coding process (e.g., listing a code such as 799.3 –Debility, unspecified or 783.7 Adult Failure to Thrive as the principal diagnosis). The hospice will then be required to provide more definitive coding. If not prevented, these coding and billing errors will result in tremendous inefficiencies (e.g., rework and longer revenue cycle times) along the Medicare Health Information Supply Chain (#MedicareHISC).

Let’s avoid these categories of waste by paying attention to the hospice principal diagnoses now. Palmetto GBA and your Chief Financial Officer will thank you in November. 

 

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