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

EXECUTIVE SUMMARY:

The objective of this review was to determine whether VNA Care Network, Inc., (the agency) complied with Medicare requirements in billing for fiscal years 2004 and 2005 services for beneficiaries who had been discharged from an acute-care hospital in the preceding 14 days. The agency improperly coded 161 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 138 of the 161 claims. Overpayments for the 23 claims not identified by the edit totaled $6,178. We recommended that the agency: (1) return the $6,178 overpayment to the appropriate 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. The agency agreed with our findings.