Claims denials suppress services.

Abstract

In recent months, provider services of many home health agencies have been suppressed due to the surge of denials of benefits for home health care. Some denials have been severe enough that permanent damage to an agency is feared. All is well, usually, until a compliance reviewer steps in and denies claims due to technical problems. More and more reviewers are interpreting the same regulations differently leading to non-covered visits, reduced interim payments and discontinuance of service to the critical patient. At this point a provider can attempt to appeal the denials--a difficult process filled with obstacles. There is a substantial and crucial need for concern by the health care industry. The situation is alarming and cries out for a plan of action--a solution.