Staying Within the Law: Home Healthcare Billing and Documentation

摘要

Audits provide a valuable tool for validating billing and documentation compliance. The Department of Health and Human Services published the results of its audit in 2012 when it determined that there was a 39% increase in home healthcare agencies (HHAs) from 2002 to 2008, and an 84% increase in Medicare home healthcare spending in 2007. A sample of 495 beneficiaries showed that: (a) 98% of the beneficiaries met the homebound eligibility requirement and needed skilled nursing or therapy services; and (b) beneficiaries were under the care of a physician. However, results also showed that HHAs received improper Medicare payments in the amount of $432 million because either wrong claim codes were used or specific services were not medically necessary. Further, the audit uncovered $462 million dollars worth of HHA claim upcoding and downcoding. As shared in the previous column, these findings flagged actual and possible fraud, contributing to the need to establish the Medicare Fraud Strike Force.