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And why you’re getting more FTF-related denials.

If you’re mixing up your patient status codes, your Medicare Administrative Contractor will be none too happy. And according to the Centers for Medicare & Medicaid Services, hospices aren’t reporting a patient’s death properly using patient status codes on claims.

Specifically, CMS identified inaccurate reporting of a patient’s death using the patient status code 40, 41 or 42 on hospice claims, CGS reports in its January 2013 Home Health & Hospice Medicare Bulletin. And if you’re like other hospices, you might want to double-check the ‘TO’ date of the claim, as well as the patient status code you reported along with it.

The problem: If you report the ‘TO’ date as the patient’s date of death (as you should), make sure you’re also reporting the appropriate patient status code -- for example, you shouldn’t use patient status code 30 (still a patient) or code 01 (discharge to home) if you’re reporting the ‘TO’ date as the patient’s date of death.

You must "report the appropriate patient status code as of the ‘TO’ date on the claim," CGS stresses. "When the ‘TO’ date of the claim is the beneficiary’s date of death, the only appropriate patient status codes would be 40 (expired at home), 41 (expired -- medical facility) or 42 (expired -- place unknown)."

Pay attention: According to CGS, other common errors found on hospice claims included the following patient status codes:

Prevent FTF Encounter-Related Claims Denials

Hospices aren’t the only ones in the limelight for coding and billing mistakes -- home health agencies are also in CGS’s crosshairs for an overabundance of claims denials related to face-to-face encounters. Claims reviews by the Comprehensive Error Rate Testing contractor revealed an increase in denials related to the home health FTF encounter, CGS says.

Beware: So you don’t get snagged for inappropriate payments (and have to pay back those reimbursements), CGS warns that you should pay close attention to the three most common errors found in the CERT denial summary:

1. The FTF documentation was not signed by a certifying physician.

2. The FTF documentation did not include clinical findings to support homebound status and/or the primary reason for home care.

3. The FTF documentation was not signed and dated, or wasn’t signed and dated prior to the claim being filed.

 CGS offers the following Medicare instructions for documenting and submitting claims for FTF encounters:

• The certifying physician must document that the FTF visit took place, regardless of who performed the encounter.

• Your FTF documentation must include:

o The date of the FTF encounter; and

o Clinical findings to support that encounter was related to the primary reason for home care, the patient is homebound, and in need of Medicare-covered home health services.

• The FTF documentation must be clearly titled and dated.

• The certification must be signed by the certifying physician prior to billing Medicare.