Wiki Radiology Services Recouped by Medicare for a Home Health Patient

[elizabethbilling]

I need some help with billing radiology services provided to a home health patient. We have been getting recoupments from Medicare on our radiology claims when the patients are assigned to home health. We've tried billing the home health agency in place of Medicare, and the home health agency doesn't know why we are billing them. How do we get reimbursement on a claim when a patient is seen for a service, like a diagnostic mammogram, when the patient is under home health? We bill POS 11. We are NOT a hospital. The services are DIAGNOSTIC, not therapeutic. If the radiology services are unrelated to the episode of care the patient is assigned to home health for, who is supposed to pay, Medicare or the home health agency? If anyone has some advice on this issue, please let me know. I have a feeling we need to appeal to Medicare and NOT bill the home health agency.

Any input would be greatly appreciated!

 

[danskangel313]

I'm certainly no specialist on Home Health, but it's always been my understanding that the contract/agreement that's made with Medicare requires the HHA to cover all of the patient's health care needs. However, while looking more into this, I found conflicting information all over the place. But I did find is this:

"Medicare’s home health benefit only pays for services provided by the home health agency. Other medical services, such as visits to your doctor, are generally still covered by your other Medicare benefits."
https://www.medicare.gov/Pubs/pdf/10969.pdf


When MC does the recoups, do they indicate the reason as to why?

And out of curiosity, are the recoups primarily for services that are, or would have been, any of the "free" preventive services? I know you said diagnostic mammograms, but I assume that had to stem from a screening at one point..?

Also, the provider ordering the diagnostic mammogram... is it the same provider who ordered the home health?