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CMS Announced the Approval for Home Health Prior Authorization Requirement

Posted on Thursday, February 11, 2016 3:13 PM

CMS announced the approval for a Medicare Probable Fraud Measurement Pilot in five states. Under the program, home health agencies are required to perform prior authorization before processing claims for services. The procedure is comparable to the PMD, which CMS implemented in 2012 and requires prior authorization for scooters and power wheelchairs within seven states with high population of fraud-and error-prone providers. The program ensures that payments for home health services are appropriate before the claims are paid, eventually leading to prevention of fraud, waste and abuse. The Medicare Probable Fraud Measurement Pilot is in the beginning stages, however an open public comment period will run until April 5, 2016. For the full article, click here.


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