OIG: Physicians unclear on home care criteria
Even though physicians are heavily involved in certifying Medicare home health services for patients leaving the hospital, hospitals face compliance risks in this area because many physicians do not understand the requirements.
In fact, 38% report they are unclear on the Medicare criteria for "homebound," and just under half say they are unclear about the definition they are expected to apply when they certify that Medicare home health services are necessary, according to a recent study by the Health and Human Services Office of Inspector General.
Bill Dombi, vice president of law at the National Association for Home Care in Washington, DC, notes that Medicare added several CPT codes to the physician reimbursement scheme so that physicians are paid for certifying and recertifying the Medicare home health care plan of treatment. However, he says, physicians were fearful because of some misunderstandings regarding a provision that could create new penalties for physicians who fraudulently sign care plans that say the patient is homebound.
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