Certified Home Health Agencies Episodic Payment System
Notification of Upcoming Audit
June 9, 2017
Dear Provider
A review of the Certified Home Health Agencies (CHHA) Episodic Payment System (EPS) has found Medicaid overpayments were made to a number of CHHA providers. These identified overpayments include:
- Improper use of discharge code when a Medicaid Recipient is transferred to a Managed Long–Term Care (MLTC) Plan;
- CHHA Provider paid for multiple episodic payments within 60 days;
- Improper use of discharge code when a Medicaid Recipient subsequently obtains services from a different CHHA.
These claims submissions are not compliant with the Billing Guidelines dated April 9, 2013, which are posted on the NYS Department of Health´s website at: Episodic Billing Guidelines 4–9–2013.
As noted in the February 2017 Medicaid Update, Volume 33, Number 2, the NYS Office of the Medicaid Inspector General (OMIG) will be issuing audit reports, pursuing recoupment of these overpayments, as outlined above. OMIG´s review encompasses claims paid from May 1, 2013 through December 31, 2016. OMIG will begin issuing draft audit reports over the course of the next two to three weeks.
Per OMIG´s standard audit practices, these draft reports will include cited regulations and exhibits, as well as information regarding due process afforded to providers subject to the audits.
