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CMS Organizes a Special Open Door Forum Regarding the Home Health Pre-Claim Review Demonstration

Posted on Monday, June 20, 2016 1:51 PM

On June 14, CMS held a Special Open Door Forum for the home health Pre-Claim Review Demonstration plan. A Notice was issued in the FR. Additionally, CMS provided a list of items that will be required for a pre-claim request, followed by questions that will be addressed from the participants.

CMS confirmed on the call that the Pre-Claim Review Demonstration was introduced as an effort to decrease fraud in the home health industry and reduce improper payments associated with insufficient documentation.

The demonstration is scheduled for three years for home health services in the following states:
• Illinois
• Florida
• Texas
• Michigan
• Massachusetts

According to the CMS officials, the home health agency (HHA) will submit a pre-claim review request to their MAC with the following information:
• Beneficiary
• Certifying Physician/Practitioner
• Home Health Agency
• Requestor
• Other Information

For the full article, click here.


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