[Amy Lawhorn]

We've recently been hit hard by Medicare takeback requests for items that were supplied to patients who were enrolled in Home Health (though we were unaware of this). The DOS for these are 2006 and 2007 and most of the patients have passed away. Has anyone found a way to recoup losses for this? Our biller has called Home Health to ask for help and got none. As far as I can tell, we were the only ones supplying and billing for the items. How can this be fair? esp. 3-4 years later.

[HEATHER]

This is a bit different scenario, but we get similar old service date
recoupments every year due to the patient being in a SNF. Usually the EOB
for the recoupment says Patient Responsibility = $0 - so it wouldn't matter
if they were living or not. And in our case there is no way the SNF will
pay for the rental of that denied w/c - I'm sure it will be the same w/ your
home health agencies. The only time we can get paid is if we find out that
the patient was at home any time during that month (I don't know if this
would apply in your case?). If the patient kept our rental equipment, we
billed for the 10th of the month and the patient was d/c on the 11th - then
we would change our billed date to the 11th and refile.

[Regina]

Who ever said that anything about Medicare was fair!? We get both of these scenarios, often. All I know is that they can't go back farther than 4 years. I found that out a few years ago when they were doing SNF take backs for 2003! Even checking for home health episodes doesn't seem to help, as sometimes it's not in the system yet.
We have tried billing the home health agency, but it has never worked. Who do the nurses think is dropping off the supplies? The wound care/ ostomy/urological fairy?! Don't they find it odd that they never have to provide the supplies they are supposed to be bringing to the patient? It really burns me up.

[DeeDee]

We are getting the same "take backs" for HHA for 2006/2007. Unfortunately, these are prior to when I came to this company. Since I have been here, on all new Medicare orders/patient's we verify insurance through the IVR. This will tell you if the patient has a current home health episode. My understanding has always been that Medicare can go back 7 years.

Also, last year we started asking on all intakes if there was a caregiver or home health agency involved with the patient or coming out to the house and who that agency is and their phone number. We were told that this was a requirement from ACHC.

[HEATHER]

One requirement (maybe it is a FL thing?) is that we have to assist special
needs patients with registering with their local Emergency Management (in
case of evacuations, etc.). If a patient has home health, they are
responsible to do the same thing - and their responsibility supercedes ours.
We just have to note the name of the HH and a phone # and we have met that
requirement. We have a list of questions right on our intake form. The
only thing about relying on the IVR is that if the patient is just being d/c
from a facility, Medicare may not have info on that HH period when you call.

[SimplyLori]

We've been getting hit bad lately as well and we do check the IVR and ask the patient or caregiver on our intake. The biggest problem for us is when existing patients change their status. I'm considering a form for my drivers to get signed when they leave the orders but of course we can't do blanket ABNs so I'm not sure. That also won't help on drop ship or UPS but it will help on some of these....

[Regina]

After Medicare was taking back our payments last year, we received a letter from them stating that they had gone back too far with 2003/2004, and they ended up returning our payments.
We have the HHA question on our intake, but I agree with SimplyLori, it is our existing patients who give us trouble.