Review of Payments Made by Associated Hospital Services for Home Health Services Preceded by a Hospital Discharge

EXECUTIVE SUMMARY:

The objective of this review was to determine whether home health agencies (HHA) were billing for services that were preceded by an inpatient hospital discharge in compliance with Medicare regulations.  Medicare prospective payments system regulations provide for a higher payment to HHAs for home health services for which the beneficiary was not discharged from an inpatient hospital within 14 days of the HHA episode.  We identified 6,388 claims in fiscal year 2001 for which it appears HHAs received a higher payment even though the beneficiary was discharged from an inpatient hospital within 14 days preceding the home health services.  Based on a stratified random sample of 200 claims, we estimate about $1.9 million in overpayments to HHAs for the 6,388 claims.  We recommended financial adjustments and internal control improvements, which were generally concurred with by Associated Hospital Service, the regional home health intermediary.

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