CMS issued an update regarding what appears to be a sharp increase in the denial rate for Skilled Nursing Facilities (SNFs) as reported in the 2015 Comprehensive Error Rate Testing (CERT) Report. The CERT Report showed denials increasing from 6.9% reported in 2014 to 11% in 2015.
What did CMS attribute as the cause of this significant increase? DOCUMENTATION
Here are some documentation requirements that CMS reported for the increase in denials resulting from missing or incomplete certification/recertification including:
As to re-certifications, the documentation should include:
Lesson to be learned: DOCUMENTATION MATTERS!
It is important that providers understand what CMS requires, and providers ensure that their documentation includes the necessary statements to avoid denials. We can help providers be proactive in providing adequate documentation to avoid denials. However, should the providers encounter the need to appeal their denied payments, we can help with the appeal process.
By Denise Bloch