Skip Navigation
United States Flag

An official website of the United States government. Here's how you know >

Change Font Size

Medicare Payments for Unallowable Overlapping Home Health Claims and Part B Claims

According to Section 1842 (b)(6)(F) of the Social Security Act, consolidated billing for all home health services is required while the beneficiary is under a home health plan of care authorized by a physician. The Act established a Medicare prospective payment system that pays home health agencies (HHA) for home services and covers all of their costs for furnishing services to Medicare beneficiaries. Pursuant to the home health consolidated billing requirements, the HHA that establishes a beneficiary’s home health plan of care has Medicare billing responsibility for services furnished to the beneficiary. Payment is made to the HHA whether or not the item or service was furnished by the HHA or by others by arrangement. We will review Medicare Part A payments to HHAs to determine whether claims billed to Medicare Part B for items and services were allowable and in accord with Federal regulations. Generally, certain items, supplies, and services furnished to inpatients are covered under Part A and should not be separately billable to Part B. Prior OIG audits, investigations, and inspections have identified this area for noncompliance with Medicare billing requirements.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
July 2017 Centers for Medicare & Medicaid Services Medicare Payments for Unallowable Overlapping Home Health Claims and Part B Claims Office of Audit Services W-00-17-35796; A-09-17-03022 2018

Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201