Review of Medicare Payments to Connecticut VNA, Inc., for Home Health Services Preceded by a Hospital Discharge

EXECUTIVE SUMMARY:

Our objective was to determine whether Connecticut VNA, Inc., (the agency) complied with Medicare requirements in billing for fiscal year 2004 and 2005 services for beneficiaries who had been discharged from an acute care hospital in the preceding 14 days.  The agency improperly coded 35 claims as if the beneficiaries had not been discharged from an acute care hospital within the 14-day period preceding the home health admission.  The Centers for Medicare & Medicaid Services's prepayment edit corrected 27 of the 35 claims.  Overpayments for the eight claims not identified by the edit totaled $3,683.  We recommended that the agency (1) ensure that its adjustments to reimburse Medicare for the $3,683 were processed by the regional home health intermediary and (2) further educate its staff regarding the importance of identifying all facilities that had discharged the beneficiary within 14 days of the home health episode and determining which of these facilities were acute care (including long-term care) hospitals.