CMS Starts New Home Health Claims Review Demo With Three Options

On Dec. 10, CMS is taking another shot at a home health pre-claim review demonstration, although calling it that would be a misnomer. Home health agencies (HHAs) will have three choices—pre-claim reviews, post-claim reviews or virtually no review in exchange for a 25% pay cut. There’s also a reward of sorts for more compliant providers.

CMS on Nov. 27 unveiled the details of its five-year Review Choice Demonstration for Home Health Services, which was developed in response to mounting evidence of fraud and abuse in home health care and the persistence of inadequate documentation to support certification of home health eligibility, according to slides on the CMS website.

Palmetto GBA, a Medicare administrative contractor (MAC), will run the demonstration, which starts in Illinois. Sometime soon, CMS will implement the demonstration in four other states—Florida, Ohio, North Carolina and Texas—but HHAs there will have 60 days’ warning. It could eventually hit additional states. The previous version of the demo began in 2016 but was suspended last year because of glitches.

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