In many post-payment overpayment cases, this seems to be the primary reason for the denial determination as assesse4 by the local ZPIC (Program Safeguard COntractor.)
The following was published by PGBA-RHHI.
5FT10/5AT10 – Documentation Does Not Support Homebound Status
Reason for Denial
The services billed were not covered because the medical records submitted for review did not support homebound status.
A beneficiary is considered to be homebound if there exists a condition due to illness or injury that restricts the ability to leave the place of residence except with the aid of supportive devices such as crutches, canes, wheelchairs, and walkers, the use of special transportation, or the assistance of another person or if leaving home is medically contraindicated.
For more information, refer to:
• 42 (CFR) Code of Federal Regulations Sections 409.42 and 424.22
• CMS Internet-Only Manuals (IOMs), Pub 100-02, Medicare Benefit Policy Manual, Chapter 7, Sections 30.1 and 30.1.1
