OASIS Alert

Published on Wed Aug 17, 2005 PDF

The HHS Office of Inspector General has hit another home health agency with huge overpayments for episodes claiming high therapy use.

Following closely on the heels of the $42,000 therapy denial reported in May for a Connecticut HHA (see OASIS Alert, Vol. 6, No. 7), the OIG also has downcoded or denied 88 percent of a California HHA's high-therapy claims it reviewed.

These results will ensure continuing review of high-therapy claims, experts predict. "That old saying 'follow the money' applies here," says Abilene, TX-based reimbursement consultant Bobby Dusek. "The simple fact is that 10 therapy visits doubles the amount of reimbursement for a normal episode."

The OIG's reviews focus on claims with 10, 11 or 12 therapy visits. Medical reviews need to deny only one to three visits to recoup more than $2,000, Dusek points out.

The OIG had regional home health intermediary United Government Services review 74 of Red Oak Home Health Services's claims with 10 to 12 therapy visits from Oct. 1, 2002 through Sept. 30, 2003, according to the newest report (A-09-04-00050).

The therapy denials resulted in about $150,000 in overpayments for Los Angeles-based Red Oak. The agency disagreed with most of the findings but admitted that documentation "may not have been of the highest standards."

Note: To see the details of the OIG report, go to www.oig.hhs.gov/oas/reports/region9/90400050.pdf. For more information about protecting your therapy claims from denials see OASIS Alert, Vol. 6, No. 7.