2020 Hospice Data Map for Arkansas

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 Arkansas.

  • Total claims reviewed: 7
  • Total dollars reviewed: $16,483.14 
  • Total claims paid: 6
  • Total dollars paid: $12,477.40
  • Total claims denied: 1
  • Total dollars denied: $4,005.74
  • Claims with error code 25 — Not medically necessary: 1

CERT Reviewer Error: 25 — Not medically necessary — Medical necessity
Hospice Services Not Reasonable and Necessary: Physician narrative was inadequate to support the beneficiary’s terminal prognosis.

Tips to Prevent this Error
Documentation to support terminal prognosis (example may include)

  • History
  • Progression of illness/disease
  • Recent changes
  • Exacerbation of symptoms
  • Comorbidities
  • Secondary conditions
  • Variables that are measureable
  • Labs
  • PPS/Karnofsky scale
  • FAST scale for Alzheimer’s patients
  • Weight loss
  • BMI
  • Percentage of meals eaten
  • Vital signs
  • IDG meeting notes

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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