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Home Health & Hospice Week

Case Study:

Homebound Status Trips Up Audited HHA

Published on Tue Aug 10, 2010

If your patient is leaving the home, you'd better show it takes a great and taxing effort. Home health agencies that have billed a lot of outlier episodes or therapy visits or otherwise had "aberrant billing" had better make sure their charts back up their claims. In a Zone Program Integrity Contractor audit that resulted in one Texas home health agency's payment suspension, ZPIC Health Integrity highlighted these beneficiaries whom its auditors deemed not homebound: • A beneficiary leaves the house to go shopping, to visit friends and relatives, and to take a taxi to receive medical care. She uses her motorized scooter to visit her brother and other friends in the neighborhood. The beneficiary also could self-inject her insulin but said it is "easier" for the HHA nurse to do so, so auditors found that she also didn't meet the requirements for skilled care. • A beneficiary who lives [...]
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