OIG comes down on Medicare physician home health billing

A new audit released Monday by the Office of the Inspector General (OIG) has brought physician billing for home health services into the spotlight.

OIG said the Centers for Medicare and Medicaid Services (CMS) is sometimes paying twice for the same service: once to the physician under Medicare Part B, and again to the home health agency under the Medicare home health prospective payment system (HH PPS).

Prior to the implementation of the HH PPS on October 1, 2000, therapy services furnished to beneficiaries receiving home health care were separately billable to Part B by outside providers such as physicians, therapists, and outpatient facilities.

In 2003, CMS instructed Medicare contractors to allow Part B payments for therapy services furnished during home health episodes whenever those services were billed with a physician specialty code.

According to OIT, beginning in 2014, CMS must rebase home health payments to improve payment accuracy for home health agencies.

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OIG said it recommends that CMS eliminate any duplicate payments when rebasing home health payments by adjusting the HH PPS rate to exclude physician-provided therapy services or by making physician therapy services subject to the consolidated billing requirement again.

CMS officials said they agreed with the recommendation and they plan to take action.

The complete OIG report can be found here.