On Augst 1, 2019, HHS posted a new provider letter entitled: Information Letter No. 19-14 Routine Home Care First 60 Days
Recoupment of Overbilling on Routine Home Care First 60 Days. The purpose is as follows:
The purpose of this letter is to inform Medicaid hospice providers that HHSC intends
to review billing for routine home care (RHC) and recoup overbilling at the higher
RHC rate. On January 1, 2016, HHSC implemented the changes the Centers for
Medicare and Medicaid Services authorized to the RHC rates in the “FY 2016
Hospice Wage Index and Payment Rate Update and Hospice Quality Reporting
Requirements” published August 6, 2015, 80 Fed. Reg. 47142. These changes
authorize hospice providers to bill at a higher RHC rate for days 1 through 60 of an
individual’s initial hospice election. The RHC rate for days 61 and later is a lower
RHC rate
Providers should read the requirements for billing at a higher rate which are outlined in the letter. The letter also includes a Frequently Asked Questions section.