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Home Health Agencies Express Their Concerns With Prior Authorization Rule

Posted on Wednesday, June 15, 2016 11:54 AM

The home health industry and lawmakers expressed their disapproval for a preauthorization requirement, which is now called the Pre-Claim Review Demonstration for Home Health Services. However, CMS ignored the comments and concerns and pushed for approval in the five selected states. Illinois will be the first state to face the requirement no earlier than Aug. 1.

“This is a big deal,” William Dombi, Vice President for Law at the National Association for Home Care & Hospice (NAHC), tells Home Health Care News. “There are a lot of challenges, a lot of questions.”

The home health agencies in the five selected states will be under a three-year demonstration, where they will be required to submit documentation for review before processing claims for services.

Home health agencies express the following concerns:
• Equipment is very different from service
• The administrative consequences involved
• The demonstration could impose even further documentation requirements on already burdened agencies, resulting in poor care changes and additional confusion for seniors seeking care
• Continuous cash flow issues
• Unclear direction and communication on what documentation is necessary to submit for review prior to a claim or how it should be submitted

Home health agencies are encouraged to prepare for what is to come.

“If we have a choice, Aug. 1 will not be the point when Illinois finds itself in this new system,” Dombi says.

For the full article, click here.


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