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OIG to Review Home Health Claims and Medicare Advantage Plans

Posted on Thursday, June 21, 2018 1:12 PM

The Department of Health and Human Services (HHS), Office of Inspector General (OIG) has issued a revised work plan that includes a review of home health claims with episode having 5-10 visits and a plan to review Medicare Advantage plans for inappropriate denials. This review would involve multiple provider types.

If a home health agency(HHA) provides four or less visits from a skilled service provider that are included in home health coverage in an episode, the home health agency will be paid standardized per-visit payment based on the service provided.  This is called Low Utilization Payment Adjustments (LUPA).  Once a fifth visit is added, an HHA will receive a full 60-day payment based on episode of care.  Since OIG has not reviewed payments for LUPA, we will review supporting documentation to determine whether home health claims with 5 to 10 skilled visits in a payment episode in which the beneficiary was discharged home met the conditions for coverage and were adequately supported as required by Federal guidance.

Source: NAHC Report

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