A new Medicare audit of home health provider VNA Care Network found common mistakes in provider compliance. But a review of 100 claims by the Office of Inspector General (OIG) included just $6,171 in overpayments of $227,626 billed.
 
The latest audit is part of a nationwide series of home health reviews. In response, VNA Care Network of Worcester, Mass., concurred with the OIG findings and noted its efforts to strengthen internal review processes.
 
The OIG identified 15 claims with errors that included a variety of challenges that many agencies are familiar with, including:
  • Nine claims with primary or secondary diagnosis codes where the medical record didn’t contain any documentation to support the diagnosis.
  • Two claims with an institutional admission when the patients were admitted to home health after a 23-hour observation.
  • Three claims with telehealth services that were not referenced in the plan of care.
  • One claim with an addendum order adjusting infusion and frequency for nutritional formula that wasn’t signed or dated by the certifying physician.
  • Two claims with face-to-face encounters that weren’t related to the primary reason for home health services.
  • One claim with physical therapy services that didn’t meet the medical necessity criteria.
  • One claim with a comprehensive assessment that didn’t include a reference to the primary caregiver’s willingness and ability to provide care.