tci Medicare Compliance & Reimbursement - 2005 Issue 24

ENFORCEMENT WATCH: OIG Eyes Suspicious Therapy Claims

Providers must meet all 10 medical necessity requirements.Make sure your home health therapy claims meet Medicare's 10-visit threshold requirements - or an audit could show that Medicare overpaid on the claim. The HHS Office of Inspector General reviewed 40 of Connecticut Home Health Care, Inc.'s Medicare therapy services claims from October 2001 through September 2002 in an audit released May 25.The OIG sampled CHHC's therapy claims with 10 or more visits during Medicare's 60-day service period or "episode," which met the 10-visit threshold.  Medicare paid CHHC's claims for 10, 11 or 12...

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