Medicare denials

[nurseamy25]

I am the Mds coordinator/adon at a nursing facility in Texas, We have been receiving Medicare denials like crazy on part A and part B, we provide the necessary documentation and all is good, but why are we getting them in the first place, it seems like every Medicare resident within a week or so of discharge from the benefits we receive denials. Someone please help me understand why! Could it be billing or something, I'm fairly new to the Mds part and I need to know if it's something I'm doing!

[Talino]

Each individual is unique. A therapist eval is crucial. As long as you can prove that the therapy plan of care justifies the need, there is no reason to modify your practices. Document, document, document... they will all be scrutinized. Be aware if anomalies are identified during the prepayment review, they may come back for a postpayment review, that means auditing claims that have already been paid.