Home Health Agencies (HHAs) have recently been a major area of focus for HHS-OIG and CMS. In fact, the new screening requirements mandated by the Affordable Care Act place HHAs in the "high risk" category. Moreover, RACs, PSCs and ZPICs have been aggressively auditing HHAs and identifying two main areas of concern.
- Homebound status: Many home health claims are being denied because Medicare contractors believe that a patient was able to leave his or her home without a "considerable and taxing effort" or other such difficulties.
- Medical need: Claims are also denied based on the belief that there was no medical need for skilled nursing services.