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Issue Number - Name
0075 - Complex Home Health Review: Documentation and Medical Necessity
Review Type
Complex
Claim Type
Home Health
Region and State
RAC 5
All HHA MACs (except for the demonstration states: Delaware, District of Columbia, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia, and West Virginia)
Date Approved
2017-12-12

Description

Medical Necessity and Documentation Review

Affected Code(s)

  • No Specific Codes

Applicable Policy References

  • Social Security Act XVIII, Section 1814 (a)(2)(C)
  • Social Security Act XVIII, Section 1815
  • Social Security Act XVIII, Section 1835 (a)(2)(A)
  • Social Security Act XVIII, Sections 1861 (m),(o),(r)
  • Social Security Act XVIII, Section 1861 (aa)(5)
  • Social Security Act XVIII, Section 1861 (gg)(2)
  • Social Security Act XVIII, Section 1891
  • 42 Code of Federal Regulations, Sections 409.41-42
  • 42 Code of Federal Regulations, Section 409.47
  • 42 Code of Federal Regulations, Sections 424.22(a)(1)(i-v)
  • CMS Pub. 100-01, Chapter 4, Section 10.2 
  • CMS Pub. 100-01, Chapter 4, Section 30.1 
  • CMS Pub. 100-02, Chapter 7, Section 30.1.1 
  • CMS Pub. 100-02, Chapter 7, Section 30.2.1                                          
  • CMS Pub. 100-02, Chapter 7, Section 30.5.1.1
  • CMS Pub. 100-02, Chapter 7, Section 30.5.1.2