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News & Press: Regulations & Policy

Pre-Claim Review Demonstration for Home Health Services is Back

Wednesday, May 30, 2018   (0 Comments)
Posted by: Robin Childers
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Tomorrow the Centers for Medicare and Medicaid Services (CMS) will publish a notice in the Federal Register that includes revisions to the Pre-Claim Review Demonstration for Home Health Services, previously paused April 1 of 2017. The demonstration is intended to help make sure that payments for home health services are appropriate through either pre-claim or post-payment review, preventing and identifying fraud, waste, and abuse of Medicare Trust Funds, as well as reducing Medicare Appeals. Initial implementation is currently proposed for the states of Illinois, Ohio, North Carolina, Florida, and Texas, with the option to expand to other states in the Palmetto/JM jurisdiction.

Under the proposal, CMS will offer choices to providers to demonstrate their compliance with CMS' home health policies. Providers in the applicable states may participate in either 100% pre-claim review or 100% post-payment review. These providers will continue to be subject to a review method until the Home Health Agency (HHA) reaches the target affirmation or claim approval rate. Once an HHA reaches the target, it may choose to be relieved from claim reviews, except for a spot check of claims to ensure continued compliance. Providers may elect not to participate in either type of review, but they'll be subject to a 25% payment reduction on all claims submitted for home health services and may be eligible for review by the Recovery Audit Contractors (RAC).

The final proposal on the demonstration is scheduled for publication in the Federal Register on May 31, 2018, but you can read the unpublished document (CMS-10599) here. We've highlighted some of the key points for you.

The deadline for comments is July 30, 2018. Please make an effort to submit comments before the deadline.

Read the final document and comment [available May 31, 2018]:

Federal Register

Review Choice Demonstration for Home Health Services FAQs for the Proposed Collection of Information [released May 31, 2018]

APTA Take Action information and link to advocacy template letter

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