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
Corridor is the nation’s preferred partner and trusted business advisor to home health and hospice providers, providing quality services and impactful results for 30 years. Focusing on key operational, regulatory and financial challenges, Corridor delivering industry-unique solutions and deep expertise in coding, clinical documentation review, compliance, billing and collections , consulting and provider staff education . At Corridor, we make the business of caring for people Better! For the most important industry updates and news that impacts home health and hospice, please make sure to sign up for our weekly newsletter to receive the latest up-to-date industry information direct to your inbox!
For additional information, please contact Corridor at 1-866-263-3795.Go Back