With an increase in the number of ADRs and medical reviews, it is important for agencies to understand how documentation that is submitted is reviewed.

For both home care and hospice, administrative documentation is reviewed prior to medical documentation.  If at any time during the process of the medical review, documentation is missing, incomplete or insufficient, the review process ends and the remaining documentation will not be reviewed.

Order of Documentation for Home Health and Hospice Reviews

Order of Documentation Review for Home Health

•        Technical components: OASIS submission, certifications/orders, (Face to Face) F2F
•        Homebound documentation
•        Intermittent skilled nursing and therapies
•        Reasonable and medical necessary skilled service
•        OASIS and coding

Order of Documentation Review for Hospice

•        Valid election statement
•        Technical components: certification statement, F2F if 3rd or later benefit period
•        (Plan of Care) POC updated every 15 days
•        Disease acuity or trajectory supports 6 months prognosis
•        Non-routine care support
•        Physician visits

Documentation must be as complete as possible to allow medical reviewers to determine the appropriateness of the billed services. Submitting complete documentation will help decrease the number of denials and  appeals which are a result of incomplete documentation.

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