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CMS Issues Plans for Pre-Claims Review for Home Health Agencies in 5 States

In an article titled “CMS Issues Plans for Pre-Claims Review for Home Health Agencies,” the National Association for Home Care and Hospice notes that CMS has officially announced the 5 states to take part in the imposed 3-year Medicare prior authorization demonstration. These states are Illinois, Florida, Texas, Michigan, and Massachusetts, and they were chosen due to high volumes of fraudulent activity. At this point, details remain fairly vague. The main driver for the demonstration is to reduce improper payment related to insufficient documentation. While audits have mostly been done well after the patient has been discharged, companies will now undergo pre-claim reviews for which they will not receive a response to until after the patient is already under care. To read more, click here

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