CMS to launch home health claim-review project in Illinois

The Centers for Medicare & Medicaid Services will launch its revised claim-review demonstration for Medicare fee-for-service home health services June 1 in Illinois. The five-year project will eventually expand to include providers in Ohio, Texas, North Carolina and Florida, with the agency providing at least 60 days’ notice before the demonstration starts in each state. As proposed last 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, with such claims remaining eligible for Recovery Audit Contractor reviews. However, CMS will calculate a provider’s approval rate on pre-claim or post-claim reviews every six months, and providers who have 90 percent or more of their reviews approved may change to select or spot-check reviews, among other options. For more information, visit www.cms.gov.