The Home Health Industry Urges CMS to Hit Pause on Pre-Claim Review

Posted on Wednesday, August 3, 2016 10:34 PM

The Medicare pre-claim review demonstration went into effect to all home health agencies in the state of Illinois on Monday. However, home health leaders continue to advise CMS to hit a pause on it.

Despite pushback and concern across the industry, CMS has moved forward with the demonstration. The home health providers collectively want to improve the improper payment rates among home health claims, but the pre-claim review process isn’t the answer.

“There are almost 200,000 Medicare patients in Illinois who may be affected,” Colin Roskey, executive vice president of the Partnership, said in a statement. “There are many home health care workers who are important in delivering health care services in the home on a daily basis. We want to work with CMS to find ways to reduce errors in filing claims. Physicians and other practitioners who order home health care want to do it correctly. We urge CMS to press the ‘pause’ button and find a better solution.”

The demonstration is underway in Illinois and will launch in the following states periodically over the next few months:
• Florida
• Michigan
• Texas
• Massachusetts

CMS explains that the demonstration is meant to reduce fraud by requiring the submission of documentation for review before processing claims for services. However, the widespread panic continues around additional administrative burdens and CMS’ broad-stroke approach to addressing fraud.

Home health agencies continue to question whether CMS and its various Medicare Administrative Contractors (MACs) are equipped to handle submissions. In response to the uncertainty, CMS reassures agencies that MACs are prepared to handle initial requests within 10 days. Also, CMS will hire additional people or offer training to ensure timely responses.

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