OIG to Target Home Health Billing Practices

A federal watchdog is planning to take a deeper look at home health billing practices nationwide.

Specifically, the U.S. Department of Health & Human Services Office of Inspector General (OIG) recently announced it intends to identify the common characteristics of “at-risk” home health agencies using data from the Centers for Medicare & Medicaid Services’ (CMS) Comprehensive Error Rate Testing (CERT) program. These characteristics, according to OIG, could be leveraged to target pre- and post-payment review of Medicare claims.

Medicare paid home health agencies approximately $18.2 billion for home health services in 2016, HHS noted. The CERT program, however, found that the 2016 improper payment error rate for home health claims totaled 42%, or approximately $7.7 billion.

Additionally, OIG plans to evaluate Medicare Part A payments to home health agencies to determine whether claims billed to Medicare Part B for services and items were permissible and in accord with federal regulations. Usually, certain supplies, items and services provided to inpatients are covered under Part A and should not be separately billable to Part B.

The agency disclosed this information in an update to its work plan.

Written by Mary Kate Nelson

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Mary Kate Nelson
Assistant Editor at Aging Media Network
When not in the newsroom, Mary Kate can reliably be found reading on her back porch, marathoning TV shows she’s already seen or overspending at Trader Joe’s.