tci Medicare Compliance & Reimbursement - 2003 Issue 42

Home Health: HHAs Preparing For M0175 Recoupments This Spring

Millions of dollars in takebacks based on patient hospital stays are on agencies' horizons.  Despite the fact that the HHS Office of Inspector General hasn't even concluded its series of reports on M0175 inaccuracies, new claims edits based on the issue are poised to recoup millions of dollars from home health agencies. The Centers for Medicare & Medicaid Services has instructed intermediaries to put in place new pre- and post-payment edits that will check whether HHAs correctly identify an inpatient hospital stay in the 14 days before home health admission, according to an Oct. 24 instruction from the...

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