Medicaid and Medicare Home Health Payments
The HHS Office of Inspector General (OIG) has issued a report entitled “Medicaid and Medicare Home Health Payments for Skilled Nursing and Home Health Aide Services.” The OIG found that Medicaid and Medicare both may be paying for the same home health services as a result of complex payment policies for services provided to dually-eligible beneficiaries and lack of clarity in the Medicare coverage policy regarding billing for unskilled and skilled nursing services. Based on a five-state review, the OIG concluded that Medicaid paid nearly $2 million for skilled nursing and home health aide services that were vulnerable to also being paid by Medicare. The OIG suggests that CMS could consider methods to better integrate Medicaid and Medicare claims processing to prevent duplicate payments. CMS also could clarify the Medicare Benefit Policy Manual to explain that unskilled services provided during a skilled nursing visit paid under the Medicare home health prospective payment system (PPS) are included in the PPS payment.
