CMS to launch home health claim-review project Dec. 10
The Centers for Medicare & Medicaid Services plans to roll out its revised claim-review demonstration for Medicare fee-for-service home health services beginning Dec. 10 in Illinois. The five-year project will eventually expand to include providers in Ohio, North Carolina, Florida and Texas, with the agency expected to provide 30 days’ advance notice. As proposed in May, providers in the demonstration states can choose to participate in either 100 percent pre-claim review or 100 percent post-payment review; those that do not participate will receive a 25 percent payment reduction on all HH claims and may be eligible for review by Recovery Audit Contractors. For more information, visit www.cms.gov. CMS introduced a similar demonstration in 2016 in Illinois, but paused it last April due to broad opposition. In comments submitted to the agency in July, AHA said that re-implementing the demonstration as proposed would reduce beneficiary access to care, penalize providers with no history of fraud, and run counter to CMS’s other HH reform efforts.