Medicare Compliance & Reimbursement

Providers must meet all 10 medical necessity requirements.

Make sure your home health therapy claims meet Medicare's 10-visit threshold requirements - or an audit could show that Medicare overpaid on the claim. 

The HHS Office of Inspector General reviewed 40 of Connecticut Home Health Care, Inc.'s Medicare therapy services claims from October 2001 through September 2002 in an audit released May 25.

The OIG sampled CHHC's therapy claims with 10 or more visits during Medicare's 60-day service period or "episode," which met the 10-visit threshold. 
 
Medicare paid CHHC's claims for 10, 11 or 12 therapy visits within an episode at a higher rate, totaling $188,827 during the sample period. Nineteen out of the 40 sampled therapy services claims were not reasonable or medically necessary and Medicare overpaid CHHC $41,940 for those claims, the OIG alleges. 

Result: CHHC should work with its Regional Home Health Intermediary to repay Medicare $41,940 for the unallowable therapy services and submit any possible Medicare overpayments for past claims, the OIG recommends. The OIG also wants CHHC to tighten its billing controls to ensure that its future therapy services are reasonable and medically necessary.

To read the OIG's audit, go to http://www.oig.hhs.gov/oas/reports/region1/10400507.htm.

Lesson learned: Use caution when billing Medicare for therapy services exceeding the 10-day threshold.