Home Health & Hospice Week

Be on the lookout for hassles over CCM payments to your ordering physicians to potentially affect referrals.

Background: The Centers for Medicare & Medicaid Services began paying docs for Chronic Care Management in 2015. Then in 2017, “CMS unbundled complex CCM from noncomplex CCM and began paying separately for complex CCM,” the HHS Office of Inspector General says in a recent report on the physician service.

In an audit of 2017 and 2018 claims from physicians and hospitals, the OIG found that “not all payments made by CMS to providers for noncomplex and complex CCM services … complied with Federal requirements, resulting in $1.9 million in overpayments associated with 50,192 claims,” the report says. Problems the OIG identified included billing CCM services more than once for the same beneficiary for the same service period, and billing for both CCM services and overlapping care management services rendered to the same beneficiaries for the same service periods.

The OIG urged CMS to recover the $1.9 million and “implement claim system edits to prevent and detect overpayments for noncomplex and complex CCM services.” CMS agreed, according to the report summary at https://oig.hhs.gov/oas/reports/region7/71905122.asp.