New at Noyce Consulting — claims
Has your Medicare administrative contractor (MAC) requested five home health patient records for pre-payment review?Did the MAC deny payment for any of them?
Survey Deficiencies May Expose Home Health & Hospice to False Claims Act Suits, Pending Supreme Court Decision
NAHC announced today (20 April 2016) that the Supreme Court is considering arguments made yesterday (19 April 2016) that billing CMS for home health or hospice services implies that the billing agency complies with all Conditions of Participation.
"The U.S. Supreme Court heard arguments on April 19, 2016 in a case that has broad implications for any provider doing business with Medicaid and/or Medicare. . .
During a spot-check quality audit, you discover that the documentation in the patient record doesn't support the amount Medicare paid for the claim. Alarmed, you search the record for any misfiled documents and ask those involved with the patient's care if key information was documented correctly. After your frantic search it is clear that Medicare overpaid your agency for the services in a payment episode several months ago.
Yikes! You know the agency must repay Medicare. But isn't it too late? Was accepting the overpayment in the first place fraudulent?