Home health providers urge CMS to ‘press pause’ on pre-claim reviews

Insurance claims forms

Photo credit: Getty/Tashatuvango

Home health providers are continuing their crusade against pre-claim reviews, urging the Centers for Medicare and Medicaid Services to “press the pause button” on a demonstration project that kicked off in Illinois earlier this month.

In an announcement. last week, the Partnership for Quality Home Healthcare expressed disappointment that CMS was moving forward with pre-claim reviews for home health providers in Illinois, arguing the pilot project could lead to poor care transitions and higher patient costs. CMS plans to expand the pilot to four other states that have shown evidence of fraud within the home health industry.  

CMS initially proposed a stricter pre-authorization pilot project, but restructured the proposal after it was met with resistance from more than 100 members of the U.S. House of Representatives.

A recent poll sponsored by Bring the Vote Home, found that 80 percent of seniors believe patient care will be delayed if a government contractor is required to approve home health claims. Nearly two-thirds of respondents opposed requiring government approval for home health services.

Still, statistics show home health fraud remains problematic in some areas of the country. According to a recent report by The Boston Globe, nine home health agencies have overbilled the state’s Medicaid program $23 million. Massachusetts is one of the four remaining states that will undergo pre-claim reviews.

- read the Partnership for Quality Home Healthcare announcement

here’s the Bring the Vote Home poll

- read The Boston Globe article