2020 Hospice Data Map for Alabama

The Comprehensive Error Rate Testing (CERT) program looks for improper payments on Medicare claims. Based on the 2020 annual report, here is the hospice CERT information for Alabama.

  • Total claims reviewed: 34
  • Total dollars reviewed: $101,265.61 
  • Total claims paid: 34
  • Total dollars paid: $101,256.93
  • Total claims denied: 1
  • Total dollars denied: $8.68
  • Claims with error code 21 — Insufficient documentation: 1

CERT Reviewer Error 21 — Insufficient Documentation — Error Subcategory Details

  1. SQ — MD Certification/Recertification is Missing or Inadequate: The physician’s certification of terminal illness that includes a brief narrative was missing.
  2. SU — Face-to-face Evaluation Is Missing or Inadequate: The face-to-face encounter note, including attestation that occurred prior to beginning of benefit period 9 was missing.
  3. SO — Plan of Care Is Missing or Inadequate: Initial comprehensive nursing assessment and authenticated IDT POC review/update prior to 07/08/XX that documents discussion with physician and includes signatures of attendees is missing.
  4. SR — Initial Hospice Assessment Is Missing or Inadequate: The initial comprehensive assessment and any available updates to the comprehensive assessment, authenticated documentation which supports terminal diagnosis of heart disease and decline in 6 months prior to hospice start of care (e.g., diagnostic testing reports, physician progress notes) are missing.

Avoid Errors for Insufficient Documentation

1. Make sure the following information is submitted in the record for review:

  • Hospice election information
  • Identification of the particular hospice that will provide care to the individual
  • The individual’s or representative’s (as applicable) acknowledgment that the individual has been given a full understanding of hospice care, particularly the palliative rather than curative nature of treatment
  • The individual’s or representative’s (as applicable) acknowledgment that the individual understands that certain Medicare services are waived by the election
  • The effective date of the election
  • The signature of the individual or representative
  • The plan of care (POC), which is reviewed, revised and documented as frequently as the beneficiary's condition requires, but no less frequently than every fifteen (15) calendar days
  • The face-to-face encounter must occur no more than 30 calendar days prior to the start of the third benefit period and no more than 30 calendar days prior to every subsequent benefit period thereafter. Specific documentation related to a face-to-face encounter requirements must be submitted for review. This includes, but is not limited to, the following:
    • The hospice physician or nurse practitioner who performs the encounter must attest in writing that he or she had a face-to-face encounter with the patient, including the date of the encounter
    • The attestation, its accompanying signature and the date signed must be a separate and distinct section of, or an addendum to, the recertification form, and must be clearly titled
    • When a nurse practitioner performs the encounter, the attestation must state that the clinical findings of that visit were provided to the certifying physician for use in determining whether the patient continues to have a life expectancy of six months or less, should the illness run its normal course

2. Comprehensive assessment

  • Physician Certification
  • Signed and dated
  • Reference to the benefit period
  • Verbal certification included, if applicable
  • Documentation that medical director is the attending, if applicable
  • Narrative/face-to-face encounter narrative
  • Documentation of clinical findings
  • Attestation

Contact Palmetto GBA JM Part HHH Medicare

Email HHH

Contact a specific JM HHH department

Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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