Coalition Urges CMS to Hit Pause on Pre-Claim Review

Home health leaders continue to urge the Centers for Medicare & Medicaid Services (CMS) to hit pause on the Medicare pre-claim review demonstration, which became active and applicable to all home health agencies in the state of Illinois on Monday.

The Partnership for Quality Home Healthcare, in particular, voiced concern that CMS has gone ahead with the demonstration despite pushback and confusion across the industry. The coalition of home health providers stressed it wants to work with CMS to improve the improper payment rates among home health claims, but that 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 be launched in Florida, Michigan, Texas and Massachusetts periodically over the next few months. It is slated to run for three years in each state after rollout.

CMS has said the demonstration is meant to reduce fraud by requiring the submission of documentation for review before processing claims for services. That way, improper payments stemming from home health claims might be avoided.

Yet fears around additional administrative burdens and CMS’ broad-stroke approach to addressing fraud are widespread. The Partnership’s cry for CMS to halt the demonstration echoes sentiments expressed across the industry, most recently from the National Association for Home Care & Hospice (NAHC), which recently submitted harsh comments to the Office of Management and Budget claiming the review program makes no sense and goes too far.

Meanwhile, home health agencies themselves have questioned whether CMS and its various Medicare Administrative Contractors (MACs) are prepared to handle submissions.

CMS has assured agencies that MACs are prepared to handle initial requests within 10 days, and that additional hiring and training has taken place to ensure timely responses.

Written by Kourtney Liepelt