Home Health & Hospice Week

M0175 overpayments come about when home health agencies fail to mark all the correct responses to the OASIS item on prior inpatient stays. If they mark that the patient had a rehab or skilled nursing facility discharge without also marking that the patient had a hospital discharge in the 14-day time period prior to admission, the episode receives an extra point in the service utilization domain.

That extra point bumps the HIPPS code up from a "J" or "L" in the fourth position to a "K" (without therapy) or "M" (with therapy). That results in an extra $200 for a non-therapy patient and an extra $600 for a therapy patient.

Underpayments occur when the reverse happens--agencies mark a hospital stay without a rehab or SNF stay when one occurred. This is a common error when patients switch bed types within a hospital, experts note.

Source: HHS Office of Inspector General, http://oig.hhs.gov/oas/reports/region1/10300500.pdf