Responding to PPS claims denials and downcoding.
Home care agencies must become aware of the claims targeting process within medical review, undertake steps to prevent adverse claim determinations, and adjust strategies when responding to these decisions through the administrative appeals process.
wad@nahc.org
William A
WA
Dombi
D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D005568:Forms and Records Control; D018574:Home Care Agencies / Q000191:economics*; D006801:Humans; D007345:Insurance Claim Review; D006278:Medicare / Q000458:organization & administration*; D017008:Negotiating; D011445:Prospective Payment System; D014481:United States