Home Health & Hospice Week

Audits:

Texas HHA Faces Closure Based On 40 Claims

When a ZPIC knocks on your door, you're already in trouble. If you aren't taking ZPICs seriously, now's the time to change your attitude. One Texas home health agency has learned just how deadly a Zone Program Integrity Contractor audit can be. In an Aug. 25 letter, Zone 4 ZPIC Health Integrity informed the Texas HHA that it completely suspended its Medicare payments and the agency's payment suspension "may last up to 180 days ... and may be extended." HI audited a "statistically valid random sample" of claims for 25 patients spanning 40 episodes, the letter notes. HI auditors also made site visits including patient interviews in the home in December 2009 and February 2010. The result: HI found that six of the 25 beneficiaries were not homebound and that three of those six "did not meet Medicare requirements for skilled care," according to the letter. (See box, this page, [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in your eNewsletter
  • 6 annual AAPC-approved CEUs*
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more
*CEUs available with select eNewsletters.

Other Articles in this issue of

Home Health & Hospice Week

View All