OASIS Alert
Prepare for Therapy Claim Scrutiny
PDF
Expect your claims with high therapy to come under even more review. “Another area in which the schemes continue to evolve is home health services,” explained an official from the HHS Office of Inspector General in a March 26 hearing for the Senate Special Committee on Aging on preventing Medicare fraud. “Although we have seen a decrease in home health payments, the area remains rife with fraud and is one of our top priorities,” said Brian Marten, Assistant Special Agent in Charge, in prepared testimony.
“Home health schemes were initially characterized by billing Medicare for expensive long term skilled nursing visits to administer insulin injections to diabetics,” Marten explained.
“However, the scheme has changed and now involves billing for physical therapy and occupational therapy.”
Start Your COP Watch
The revised home health conditions of participation are on deck — again, said Pat Sevast with the Centers for Medicare & Medicaid Services at the National Association for Home Care & Hospice’s March on Washington conference.
“I’ve used this slide every year” for the last nine years, Sevast admitted in a March 24 CMS panel. But “it’s very true this year,” she insisted. The COPs “are further along than I have ever seen them.” If they don’t get delayed again, expect to see the COPs in the Federal Register around June.
Get a Grip on Your Top Denials
Welcome these new fact sheets from one HHH Medicare Administrative Contractor. “CGS has developed home health denial fact sheets for five specific denial reason codes to assist home health clinical staff in avoiding medical review denials,” the MAC says.
The codes covered include 5FFTF (Missing/Incomplete/Untimely Face-to-Face Encounter); 5HHBD (Homebound Status Is Not Supported in the Record); 5HMED (Medical Necessity Is Not Supported in the Record); 5HNOA (No OASIS Assessment in the Medical Record); 5HPLN (Missing Incomplete/Untimely Plan of Care); and 5HORD (Missing/Incomplete/Untimely Orders).
Links to the fact sheets are online at www.cgsmedicare.com/hhh/pubs/news/2014/0314/cope25027.html.
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Prepare for Therapy Claim Scrutiny
Expect your claims with high therapy to come under even more review. “Another area in [...]