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Dear
Hospital Billing Department,
We
received a claim for patient’s name and demographic
information. Explain the dates of services etc.
The
Medicare Home Health Agency Manual Section 201.12 Coverage of
Services states in part “the law governing the Medicare home
health PPS requires the HHA to provide all bundled home health
services (except DME) either directly or under arrangement while
a patient is under a home health plan of care during an open
episode”. It further states “The HHA must provide the covered
home health services (except DME) either directly or under
arrangement.” And finally it states “Once the patient is
discharged, the HHA is no longer responsible for providing home
health services including the bundled Part B medical and therapy
services.”
The patient in
question did not receive these services as part of a Home
Health Plan of Treatment from our agency, nor did our
agency provide this treatment either directly or under
arrangement. Therefore, we can not be responsible for
these claims or any further claims under the same circumstances.
It is
our policy to check with Medicare prior to admitting a
patient to home health services for any potential problem with
payment. I suggest that your hospital implement a
similar policy.
If you
have any questions or comments, or if I can be of further
service, please don’t hesitate to contact me at
Sincerely,
Billing
Department
Enclosures:
*Please note that this letter is simply an
example of what some home health companies have used to reply to
a hospital that is attempting to collect for services rendered
by the hospital during an active home health episode and should
not be construed in any way as legal advice by
HomeHealthRecruiter.com, Inc. We are not a firm in
the legal industry. |