10% of Medicare Claims Are Rejected, Impacting Home Health

April 9, 2018

Claims can be rejected for a variety of reasons. The most recent data from the Centers for Medicare & Medicaid services show the denial rate hovering around 10%. No two insurers are alike, some will cover one thing while another will not. Medicare has specific guidelines for covering home health, and in order to ensure that the treatment your company provides will be paid for, it’s important to know what these guidelines entail.

Examples Of Reasons Claims Could Be Denied

A study by the Advisory Board in 2014 revealed that about 90% of claim denials are preventable. Knowing the typical reasons for a claim to be rejected will help you understand how to prevent the rejections from occurring. Some common reasons for denial are:

The treatment or medical service is unlikely to assist in improving the patient’s health condition
The patient is likely to require care for a long time
The patient does not qualify for Medicare-covered home care because they are not homebound
The dosage level of a prescription is considered too high
There were technical errors made in the Medicare claim

Home Health Care Covered By Medicare

The home health claims that are covered by Medicare require the following:

A physician has or will sign the plan of care for the home health services
The patient is proven to be homebound
Face-to-Face: The patient can provide a narrative from the physician that describes their clinical condition and how it supports their homebound status
The patient requires the care of a skilled nurse on a daily basis or physical or speech therapy
The care must be provided by a provider certified by Medicare

Services that can be covered by Medicare include:

Physical, occupational, or speech therapy
Medical social services directed by a physician
Intermittent nursing care by or under the supervision of a registered professional nurse
Part-time or intermittent services of home health care permitted by Medicare regulations

Claims are rejected quite frequently and beneficiaries have a legal right to an Expedited Appeal. This may occur if the home health provider wants to discharge them or discontinue their Medicare-covered skilled care.

How Medical Billing Services Can Help

There are a lot of requirements when it comes to home health care coverage that is deemed acceptable by Medicare. Furthermore, every insurance company is going to have its own set of requirements and, as healthcare providers, these details can be a huge hassle to evaluate. Precision Medical Billing knows exactly what each insurance company requires and how to handle claims responsibly. By using our services, your company will be guaranteed:

Faster payment and increased cash flow
Reduced administrative errors that negatively affect claims and payment processing
Detailed reports and notifications communicating corrections
The ability to follow a claim’s status easily through the payment process
A team focusing on your revenue cycle so you can focus on patient care

Your patient’s claims shouldn’t be causing you stress, let the experts handle your medical billing. At the end of the day, you will have more time to focus your energies where they are most needed and know that your company’s finances are in order. For more information on medical billing, contact us here.