Don’t Be a Statistic! Accurately Code & Bill Your Home Health Claims.
On February 14, 2012, the Health Care Fraud Prevention and Enforcement Efforts announced that their efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This was the “largest sum ever recovered in single year” from Medicare overpayment and healthcare fraud.
To combat fraud, the OIG workplan for 2012 reports that CMS will be implementing Medicare Administrative Contractors’ Oversight of Home Health Agency claims. One of the purposes of these MACs is to reduce payment errors by preventing initial payment of claims that are not compliant with Medicare’s coverage, coding, payment, and billing policies. To detect and deter fraud, MACs may use a variety of methods such as, but not limited to: data analysis, prepayment claim reviews, post payment claim reviews, extrapolation claim reviews, and medical reviews to target and identify claims and/or providers with suspicious characteristics.
What should you do to prepare?
- Create an internal audit to make sure your OASIS assessment supports what is being coded.
- Educate your staff on the most current updates with CMS and ICD-9 coding guidelines.
- Never upcode your claims. Sometimes this is unintentional due to lack of documentation, but only code what is documented. If you aren’t sure, call the physician and get clarification.
- Get familiar with the steps to file an appeal should the need arise.
By focusing on what you can do now, you will reduce the likelihood of any hiccups in the future.