Corporate Compliance

Review of Medicare payments for home health services preceded by a hospital discharge

Compliance Monitor, December 12, 2007

The OIG wanted to determine whether or not Partners Home Care located in Waltham, MA complied with Medicare requirements in billing for services for beneficiaries who were discharged from an acute care hospital in the preceding 14 days.

The OIG found:

  • The agency improperly coded 231 of the claims as if the beneficiary had not had an acute care stay in the preceding 14 days
  • The 48 remaining claims represented overpayments of $16,443

The OIG recommended:

  • The agency ensure that its adjustment for the $13,451 in overpayments for the 28 claims was processed by the regional home health intermediary
  • Give back the $16,443 in overpayments associated with the remaining 48 unadjusted claims to the regional home health intermediary
  • Educate its staff on the importance of identifying all facilities that had discharged the beneficiary within 14 days of the home health episode and determining which of these facilities were acute care hospitals

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