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Medicare Payments for Home Health Comorbidity Adjustments

Announced on  | Last Modified on  | Project Number: OEI-04-26-00070
Status
Active
Agency
Centers for Medicare and Medicaid Services

OBJECTIVE

Medicare payments to home health agencies (HHAs) exceeded $16 billion in calendar year 2024. These payments are adjusted by the case mix of the enrollees receiving services. HHAs receive higher payments when diagnosis codes indicate specific comorbidities, and CMS data show that about 70 percent of claims received a comorbidity adjustment in 2023 and 2024. To determine the extent of potential improper HHA coding and potential savings, we will analyze a subset of HHA claims that received increased payments for select comorbidities and assess whether non-HHA claims also identified the same condition.

TIMELINE

  • December 15, 2025
    Announced
  • Today
    Office of Evaluation and Inspections In-Progress
  • Est FY2027
    Estimated Fiscal Year for Project Completion
Work Plan Type
Office of Evaluation and Inspections
HHS Agencies
Centers for Medicare and Medicaid Services
Issue Areas
Financial Stewardship Non-institutional care
Target Groups
Elderly
Financial Groups
Medicare A Medicare B