2019 Medicare Home Health Maximization Services Initiative

The Office of the Medicaid Inspector General (OMIG) has sent a letter to selected home health providers to resume the semi-annual demand billing process for the Federal Fiscal Year (FFY) 2019 Medicare Maximization Services Initiative. This process is to ensure that providers seek reimbursement from Medicare and all other third parties before submitting a claim to Medicaid (Section 540.6(e)(1) of Title 18 NYCRR).

OMIG contracts with the University of Massachusetts Medical School (UMass) to perform the Medicare Home Health Appeals Initiative. The Aug. 19, 2019 letter from OMIG informs agencies which dual-eligible Medicare/Medicaid beneficiaries they are required to submit to Medicare for a coverage determination. OMIG is requesting that agencies demand bill each beneficiary for claims falling between Oct. 1, 2018 and March 31, 2019 and include both fee-for-service (FFS) and Episodic Payment System (EPS) claims. If your agency is selected for future initiatives, you will receive a separate notification letter and Case Selection Report at that time.

For specific questions about the Medicare Home Health Appeals Initiative, contact Laurie Burns of UMass at 866-626-7594. If you want to know if your agency is listed on the FFY 2018 – Semiannual Case Selection Report, please contact Meg Everett.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871