Editor’s Picks: Pre-Claim on its Way

This week, Home Health Care News readers were still worked up over the news that the Centers for Medicare & Medicaid Services (CMS) was moving forward with its prior authorization program. We were eager to share how the industry was reacting as well as more information the agency provided in a forum.

Here in the newsroom, we we kept our eyes on an emotional video featuring women and men diagnosed with Alzheimer’s disease and the memories they don’t want to forget.

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CMS Launches Home Health Prior Authorization—Despite pushback from the home health industry and lawmakers, CMS announced it intends to move forward with a preauthorization requirement. CMS’ plans for prior authorization, now dubbed the Pre-Claim Review Demonstration for Home Health Services, will roll out in five states as announced in February.

Home Health Agencies Grapple with Prior Authorization Rule—Home health providers and associations were quick to denounce a preauthorization requirement after CMS revealed it will move forward with its formerly announced plans. Across the board, industry officials expressed disappointment and concern with the CMS plans for prior authorization. The home health sector criticized CMS for dismissing the comments and concerns from lawmakers and health care service providers, instead pushing forward the demonstration for home health care in Illinois, Florida, Texas, Michigan and Massachusetts.

CMS Addresses Concerns Over Home Health Pre-Claim Reviews—Days after unveiling a preauthorization requirement for home health agencies, providers expressed confusion and concern as CMS attempted to clarify what the plan entails. The new preauthorization measure aims to crack down on Medicare fraud, waste and abuse in five states. Among the many questions and concerns brought forth by providers, most seemed preoccupied by administrative burdens, timely responses and documentation requirements involved with the demonstration.


Around the Web

Victim Vignettes: A Look at Those Killed in Orlando Shooting—A social worker with a home health care agency was among the victims of the Orlando mass shooting at Pulse Nightclub on June 12. Enrique L. Rios, 25, was killed while on vacation for a friend’s birthday celebration in Orlando. He lived in Brooklyn, New York.

Federal Agency Wrongly Fined Business Over $800,000 for Breaking Regulations that Didn’t Exist Yet—“What happens if we reach the point where even these legislating agencies don’t now what their own ‘law’ is?” Forbes writes of Judge Neil Gorsuch’s  decision in favor of a home health agency that was ordered to cough up $800,000 to the Centers for Medicare & Medicaid Services (CMS). HHCN covered the issue last month, noting that CMS was “confused about its own law” when it originally alleged a Kansas City, Kansas, home health agency had improperly billed Medicare for services.

Amy’s Adds

A touching video shares the memories that men and women diagnosed with Alzheimer’s disease never want to lose.

Written by Amy Baxter

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