Home Health & Hospice Week

Extrapolation of claims errors may not bedevil home care providers as much under prospective payment as it did under cost-based reimbursement, but it’s still a big threat hanging over agencies’ heads. Now the industry has a heavy-hitting ally on its side against the practice.

The American Hospital Association is asking HHS Secretary Sylvia Burwell to rethink the way the HHS Office of Inspector General calculates Medicare errors when completing audits. The AHA believes that extrapolation — using a small sampling of claims to calculate an error rate, and then using that error rate to estimate the complete misbilled amount among the entire entity’s charts — is a flawed system, and would like it to be eliminated, wrote the AHA’s Rick Pollack in a recent letter to Burwell.

“The OIG’s approach grossly exaggerates estimated Medicare overpayments, leads to excessive recoveries by Medicare contractors, and otherwise prejudices and burdens hospitals,” Pollack says in the letter.