Oct 3, 2018, 10:58 AM
NPHI met with CMS Administrator Seema Verma about the issues related to ongoing audits that are leading to claims being routinely denied based on an overly simplified conclusion that the documentation fails to show continuous “terminal decline”, as clinically defined by the MAC, ZPIC, and other contract reviewers rather than as clinically defined by and certified by the clinical judgment of the certifying physicians.