OBJECTIVE
Medicare requires providers to bill claims accurately to be paid correctly and promptly by Medicare Administrative Contractors (MACs). During previous home health agency compliance work, we observed claims where providers incorrectly billed single-discipline visit units (greater than 8 hours) that resulted in overpayments equal to the outlier payment. MACs pay outlier payments on home health claims for enrollees who incur unusually large costs that are determined by the visit units billed on the claim. Nationwide home health claims data for the most recent 30-month period shows that the average duration of a home health visit is 45 minutes. Our audit will cover Medicare outlier payments for home health visits for single disciplines that were billed in excess of 4 hours. Our objective is to determine whether selected home health claims with outlier payments complied with certain Medicare billing requirements.
There are 2 projects in this series.
Project titles will remain unpublished until projects are complete and reports are posted.
ACTIVE PROJECTS IN THIS SERIES (2)
TIMELINE
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November 17, 2025Series Number SRS-A-26-018 Assigned
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November 17, 2025Project Announced
Project OAS-26-05-001
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March 13, 2026Project Announced
Project OAS-26-05-072
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Today2 Projects In-Progress
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Est FY2027Estimated Fiscal Year for Series Completion