Recovery auditors (RACs) have extended their reviews to another provider type following reports of overpayments and fraud.

Home health agencies, which have been under scrutiny for medical necessity of therapy services and patient eligibility, are now the target of an issue posted last week by Region C RAC Connolly.

The RAC will conduct automatic reviews to examine partial episode payments (PEPs), which occur when a patient transfers to another agency during a standard 60-day episode, for example.

While the first home health issue is an automatic review, agencies could see complex reviews in the future. Services, such as therapy, that have led to fraud allegations or overpayments would require auditors to examine documentation to determine medical necessity.

RACs Post 19 Issues

Including the home health issue, Connolly posted 18 issues that were approved Jan. 27 for inpatient hospitals, physicians, durable medical equipment (DME) suppliers, outpatient hospitals and ambulance providers.

HealthDataInsights, the Region D RAC, posted one physician issue.


About the Author

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation’s leading independent authority on home healthcare business, regulation and reimbursement.

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