The Centers for Medicare & Medicaid Services yesterday issued a notice detailing proposed changes to a claim-review demonstration project for Medicare fee-for-service home health services. CMS proposes implementing the demonstration in Illinois, Ohio, North Carolina, Florida and Texas, with the option to expand to other states. CMS said providers in the demonstration states could participate in either 100% pre-claim review or 100% post-payment review. Providers who do not wish to participate in the claims’ reviews have the option to furnish HH services and submit the associated claim for payment without undergoing such reviews; however, they would receive a 25% payment reduction on all claims submitted for HH services and may be eligible for review by the Recovery Audit Contractors, CMS said. In 2016, in one of the target states, CMS began to roll out a prior iteration of this demonstration. However, following broad opposition to the initial demonstration’s design flaws, the agency paused the demonstration in April 2017. “AHA is very disappointed that, like the original demo, CMS is again proposing a state-wide intervention that burdens all home health agencies instead of using its proven, data-driven tactics to target specific types of fraud and high-risk areas and providers,” said Rochelle Archuleta, AHA director of policy. The notice will be published in tomorrow’s Federal Register, and CMS will accept comments for 60 days.

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