Home health

Are More Home Health Program Integrity Initiatives on the Horizon?

(April 22, 2015): Late last month, the Department of Health and Human Services, Office of Inspector General (HHS-OIG) released its 2015 “Compendium of Unimplemented Recommendations” (Compendium). Published annually, the Compendium sets out the top 25  program integrity issues previously identified by HHS-OIG that are expected to “most positively impact HHS programs in terms of cost …

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CMS Has Clarified the HHA Definition of When a Patient is Confined to Home

(August 26, 2014): On August 1, 2014, the Centers for Medicare & Medicaid Services (CMS) issued Transmittal 192, clarifying their definition of when a home health patient is considered to be Confined to Home as described in the Medicare Benefit Policy Manual. This clarification more accurately articulates the Homebound definition found in the Social Security …

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Medicare ALJ Appeals of Denied Home Health Claims

(February 11, 2014):  Has a Zone Program Integrity Contractor (ZPIC) denied your home health claims?  If you believe that these denials are unwarranted, your home health agency (HHA) may challenge the denials through Medicare’s administrative appeals process.  Medicare’s appeals process provides five levels of appeal. The first four levels of appeal are before different administrative …

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Health Integrity Educational Letter Sent to Home Health Agencies in Texas and Oklahoma

(November 8, 2013):  Health Integrity serves as the Zone Program Integrity Contractor (ZPIC) for Zone 4.  This zone is comprised of Texas, Oklahoma, New Mexico and Colorado.  Generally, Health Integrity has been assigned responsibility for handling Medicare Part A, Medicare Part B, and Durable Medical Equipment (DME) claims.  Health Integrity has been especially aggressive in its …

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Home Health Compliance Risks are a Significant Issue for Texas and Oklahoma Agencies

(March 21, 2012): Over the past few weeks, several important events have occurred which should have home health agencies in Texas, Oklahoma and the rest of the country rethinking the adequacy of their existing compliance efforts. The home health compliance practices of many agencies have long been a concern of the Department of Health and Human …

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MFCU Strike Force Teams are Taking Aim at Home Health Providers

(July 19, 2010): Home health care providers are in the crosshairs again.  On July 15, HHS granted Florida a waiver of the anti-data mining provisions of federal Medicaid program regulations that will allow its Medicaid Fraud Control Unit (MFCU) to begin seeking out reasons to investigate home health and other providers for fraud.  While Florida …

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