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
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
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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