Demand Billing Resumes for Home Health Providers

The NYS Office of the Medicaid Inspector General (OMIG) contracts with the University of Massachusetts Chan Medical School (UMass Chan) to administer the Medicare Home Health Appeals Initiative. Under this initiative, providers are required to seek reimbursement from Medicare and all other liable third parties for home health services rendered to dual-eligible Medicare/Medicaid beneficiaries in accordance with 18 NY Codes, Rules, and Regulations (NYCRR) 540.6(e).

Letters were sent for delivery April 8^th to certain Certified Home Health Agencies (CHHAs) for the Federal Fiscal Year (FFY) 2023 Medicare Home Health Maximization Services Initiative.

Providers contacted for this initiative should have received a Demand Bill Directive like this sample document. This directive was sent to all providers selected to submit claims to Medicare for the second half of the FFY 2023 Medicare Home Health Maximization Services Initiative. The Episodic Payment System (EPS) claims selected for this initiative fall between April 1, 2023 and Sept. 30, 2023, or until the end of the episodic period billed to Medicaid.

Providers with questions may contact Erin Devaney of UMass Chan at 617-886-8219. Members may contact Meg Everett to find out if their agency is on the list of contacted providers.