Under the home health prospective payment system (PPS) during calendar years 2015 and 2016, the Centers for Medicare & Medicaid Services paid home health agencies (HHAs) a standardized payment for each 60-day episode of care that a beneficiary received. The PPS payment 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.Our prior audits of home health services identified significant overpayments to HHAs. These overpayments were largely the result of HHAs improperly billing for services to beneficiaries who were not confined to the home (homebound) or were not in need of skilled services. Our objective was to determine whether Visiting Nurse Association of Maryland (VNA) complied with Medicare requirements for billing home health services on selected types of claims.
MD,
United States
