Home Health & Hospice Week

Close to half of errors were due to face-to-face.

Utah home health agencies may be in for some rough review times.

Last October, Medicare Administrative Con-tractor CGS announced that it would conduct a widespread review of claims with 10 or more therapy visits submitted by Utah home health agencies. In its Medicare Bulletin for July, CGS reveals that it denied79 of the 100 claims it reviewed in the probe.

CGS initiated the probe after analysis showed “greater aberrancies among home health providers in the state of Utah” in reimbursement per claim, total visits, and therapy-related benchmarks, the MAC says in its newsletter. The HHS Office of Inspector General also included Utah as one of eight states containing agencies with a high percentage of questionable billing.

The lion’s share of denied claims — 37, or 43 percent of the erroneous claims — were due to face-to-face physician encounter reasons. Those problems may be alleviated if the pending proposal to eliminate the physician’s face-to-face narrative is finalized.

But a handful of other reasons are responsible for the remaining 49 denials, ranging from unsupported medical necessity (23 claims) to no OASIS assessment submitted (4 claims) to unsupported homebound status (3 claims), CGS says.

More review: CGS will implement a service-specific edit for claims with 10 or more therapy visits submitted by Utah HHAs, it indicates in the newsletter.

Meanwhile, the other seven states singled out by the OIG in the questionable billing report should expect the same treatment, experts predict. They are Florida, Texas, California, Oklahoma, Michigan, Louisiana and Ohio.