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Gov’t audit insider: Home health reimbursement

Healthcare Auditing Weekly, April 13, 2004

Claims submitted to Cahaba regional home health fiscal intermediary came under Office of Inspector General (OIG) scrutiny, the OIG says in an audit report released March 31. The audit examined reimbursement for beneficiaries who received services 14 days after discharge from inpatient hospitals because home-health patients often receive unnecessarily high levels of service in the first 14 days after discharge, the OIG says.

To uncover such unnecessary services, the OIG performed the following tasks:

• Reviewed appropriate Medicare laws and regulations
• Extracted paid claims that home health agencies (HHAs) submitted with codes pointing to no hospital discharge within 14 days before the home health admission
• Matched the selected claims to data on hospital inpatient stays and determined which beneficiaries received inpatient services
• Calculated overpayments for such beneficiaries
• Asked the fiscal intermediary to perform a similar calculation and compare results
• Discussed the findings of the review with Cahaba officials and provided them with a file containing the population of claims with overpayments

The HHAs under Cahaba's jurisdiction are now a part of its reimbursement lapse. Your fiscal intermediary could be making the same mistake that Cahaba, and it could cost you in the long run.

Click here to view the OIG audit report, "Review of payments made by Cahaba Government Benefit administrators for home health services preceded by a hospital discharge."

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