tci Medicare Compliance & Reimbursement - 2008 Issue 11

Fraud & Abuse: CMS Limits Home Health Aide Visits In Fraud-Prone Area

System will automatically deny claims with more than 3 aide visits per week Legitimate home health agencies (HHAs) in the Miami area that serve patients with high aide needs have been slapped with a major burden. As of March 1, the Medicare claims system started denying claims that contain three or more aide visits per week and qualify for outlier payments, according to a letter Medicare's home health Program Safeguard Contractor (PSC) in Florida, TriCenturion, faxed agencies in Miami-Dade County in mid-February. HHAs can appeal denied claims for more aide visits, says TriCenturion in the letter. But "TriCenturion may...

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