Medicare Home Health Agency Provider Compliance Audit: Mercy Health Visiting Nurse Services

Medicare Parts A and B cover eligible home health services under a prospective payment system (PPS). The PPS covers part-time or intermittent skilled nursing care and home health aide visits, therapy (physical, occupational, and speech-language pathology), medical social services, and medical supplies. Under the home health PPS, CMS pays HHAs for each 60-day episode of care that a beneficiary receives.In prior years, our audits at other HHAs identified findings in the following areas:• beneficiaries did not always meet the definition of “confined to the home,”• beneficiaries were not always in need of skilled services,• HHAs did not always submit OASIS data in a timely fashion, and• services were not always adequately documented.For the purposes of this report, we refer to these areas of incorrect billing as “risk areas.”Our objective was to determine whether Mercy complied with Medicare requirements for billing home health services on selected types of claims.