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Home Health & Hospice Week

Audits:

Homebound Audits Put HHAs' Reimbursement At Risk

Published on Tue Oct 26, 2010

Are you committing one of these 8 frequent homebound sins? If your patient records fail to convince auditors the patients are homebound, you will face major recoupments. That's the situation many home health agencies are finding themselves in, report industry experts. HHAs are undergoing medical review focusing on homebound criteria from Zone Program Integrity Contractors (ZPICs), Program Safeguard Contractors (PSCs), and intermediaries. For example: Recently a Texas HHA saw a complete suspension of Medicare payments, after Zone 4 ZPIC Health Integrity found six of 25 beneficiaries whose records it reviewed were not homebound (see Eli's HCW, Vol. XIX, No. 32, p. 252). State surveyors are also focusing on homebound criteria, industry veterans report. Homebound criteria has been a long-standing issue for Medicare's home health benefit, notes attorney Marie Berliner with Lambeth & Berliner in Austin, Texas. That's because it's one of the few criteria patients must meet to qualify for home [...]
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