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Medicare Compliance & Reimbursement

IN OTHER NEWS ...• CMS is keeping the heat on

Published on Thu Jan 15, 2009

• CMS is keeping the heat on home health agencies in South Florida over abuse of outlier payments. The agency suspended payment for 10 HHAs in October over outlier issues, CMS finally officially announced in a Dec. 29 press release. CMS hasn't suspended any more Miami-area agencies' payments, but it is zeroing in on questionable physician relationships to get at the problem. CMS is "implementing extensive pre- and post-payment review of claims submitted by ordering/referring physicians" and "validating claims submitted by physicians who order a high number of certain items or services by sending follow-up letters to these physicians," CMS says in the release. Further, the agency is "verifying the relationship between physicians who order a large number of home health services and the beneficiaries for whom they ordered those services," CMS says. In person: The agency is also "identifying and visiting high risk beneficiaries to ensure they are appropriately receiving [...]
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