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NAHC’s Harsh Comments Are Submitted to the Office of Management (OMB) About Pre-Claim Review

Posted on Wednesday, July 27, 2016 8:36 PM

Pre-claim review continues to get criticism from industry groups. With that being said, NAHC recently submitted harsh comments to the OMB about the pre-claim pilot program by CMS.

The demonstration is set to begin in the five following states: Illinois, Florida, Michigan, Texas, and Massachusetts—sporadically over the next year, with Illinois beginning on August 1, 2016.

CMS noted that the demonstration’s goal is to reduce fraud, however NAHC argued that the program consists of several downfalls for home health care companies.

“The proposal is untargeted, with high administrative costs and operational burdens, is likely to create improper barriers to access to timely care, would not be effective against the fraud concerns in Medicare home health services, and would not aid in achieving a higher degree of compliance with the alleged claim documentation deficiencies,” NAHC wrote.

Since the proposal first appeared on the Federal Register at the beginning of 2016, the industry has shown extreme backlash. Home health agencies are concerned with the high administrative burden, especially since they’ve already challenged CMS officials on their ability to process the additional requirements and their own ability to secure proper documentation from physicians.

NAHC has encouraged the OMB to give CMS instructions to withdraw the proposal for prior authorization completely.

For the full article, click here.


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