The NHIC, Corp. Medical Review Department has recently completed a review of home health claims with five-seven visits billed. Of the 80 claims review, 28 were paid as billed. The remaining 52 claims had some denials resulting in a claim denial rate of 65%. The total charges reviewed included $72,694.98 of which $32,749.95 was denied. This resulted in a charge error rate of 45%.
The majority of the claims were denied because the skilled nursing services were not supported as being medically necessary in the medical records. Read more in the educational article Review of Home Health Claims with 5-7 Visits
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