3 actions doctors can take as OIG scrutinizes home visits

While house calls by primary care physicians and other types of home visits provide many benefits, they have also come under scrutiny by the Office of Inspector General (OIG) in 2017.

Given that focus, it’s important that doctors know the Medicare rules for home visits and carefully document the reasons for those house calls, writes Gregory A. Hood, M.D., an internist from Lexington, Kentucky, in a Medscape article (reg. req.).

The OIG 2017 Work Plan established a priority for audit of home visit claims, Hood says, making it essential that doctors make sure their house calls can pass such an audit.

House calls are an intermittent part of his own practice, Hood says, and provide information that may be impossible to uncover in an office visit. Take for instance his elderly patient who began to suffer an unexplained exacerbation of her emphysema. A home visit found she had adopted a kitten.

Since reimbursement updates in 1998 led to an increase in home visits, as well as the growth of companies that provide home visits, the OIG has questioned whether all of the visits are medically necessary, Hood says. The visits cannot be for the convenience of the patient, the patient’s family or the physician or other provider.

Be prepared to show the visit is necessary, he says, whether it is a one-time visit or in response to ongoing patient needs. Document those reasons and recognize that specific requests by patients or medically appropriate judgments and standards of care in treatment protocols and monitoring, such as a patient who is not physically capable of traveling to the office or has psychological difficulties, are more likely to pass an audit. Hood says physicians should follow these three steps:

Familiarize yourself with Medicare rules, specifically section 30.6.14.1B, which outlines home health benefits.

Review the Current Procedural Terminology codes with your billing staff as they relate to locations for home services such as assisted living facilities or group homes.

Document the facts, such as how the visit was initiated and what occurred, as well as the need for any future visits and the rationale for why they may be required outside the medical office.