Home Health & Hospice Week

Medicaid:

OVERLAPPING HOME CARE SERVICES COULD MEAN MEDICAID OVERPAYS

Published on Tue Jan 13, 2009

New OIG report should be a 'wake-up call' for HHAs, trade group warns.

If you're confused about exactly which aide and nursing services Medicare covers versus Medicaid, you're not alone -- it seems the feds are a bit fuzzy on the concept too.

Out of $3.3 million in aide and nursing services the HHS Office of Inspector General reviewed for a new report, the OIG deemed $2 million as "vulnerable" to inappropriate payment by Medicaid.

In counting at-risk payments for aides and nurses, the OIG counted any Medicaid-paid visits that occurred during a Medicare PPS episode and that were part time or intermittent. Without a detailed medical review, the OIG couldn't determine if the visits were actually incorrectly paid by Medicaid or not,the agency admitted.

Pitfall:Acommon mistake home health agencies make is to bill Medicaid for a visit when a nurse performs a service that Medicare doesn't cover, like administering eye drops or filling medication boxes.But if the nurse performs those types of tasks in addition to a Medicare-covered skilled service during the visit, Medicare should pay for the visit and not Medicaid, the OIG pointed out.

"CMS could ... provide greater clarity in the CMS 'Medicare Benefit Policy Manual' to explain that unskilled services provided during a skilled nursing visit paid under the PPS are included in the PPS payment," the OIG suggests.

Pay attention: "The OIG Report is a wake-up call to home health agencies to ensure billing accuracy," warns the National Association for Home Care & Hospice. "Home health agencies should not bill Medicaid for services furnished to dually-eligible individuals if there is Medicare coverage for the furnished services."

There were "significant deficiencies" in the OIG's research methodology in the five states surveyed for the report -- Florida, North Carolina, Ohio, Maryland, and Texas, NAHC says. But "the potential billing vulnerabilities identified by the OIG merit the attention of the home care industry," the trade group allows.

Note: The report is at www.oig.hhs.gov/oei/reports/oei-07-06-00641.pdf.

Home Health & Hospice Week

Prospective Payment System; RECONCILE YOUR PPS CLAIMS OR RISK LOSSES
Don’t let the confusing PPS refinements trip up your billing. If you don’t keep on [...]

Reimbursement:
PPS ADJUSTMENTS HIT HANGUPS
Don't touch these suspended claims. Your wait for your corrected prospective payment system claims may [...]

Competitive Bidding:
CMS PROPOSES BIDDING DELAY -- BUT NOT FOR LONG
Suppliers give Congress an earful at hearing about the program. Suppliers may not be getting [...]

Medicaid:
OVERLAPPING HOME CARE SERVICES COULD MEAN MEDICAID OVERPAYS
New OIG report should be a 'wake-up call' for HHAs, trade group warns. If you're [...]

Industry Notes:
NATIONWIDE RAC PROGRAM COMING SOON
Temporary hold-up resolved, CMS says. The Centers for Medicare & Medicaid Services' Recovery Audit Contractor [...]

Final Claim Payment Variance Worksheet

View All