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Update: Review Choice Demonstration for Home Health Services

July 05, 2018
Documentation, Billing, & Coding By Patty Klinefelter, Director

As a follow up to the April 2017 Home Health Pre-Claim demonstration, the Centers for Medicare and Medicaid Services (CMS) is proposing a revision titled “Review Choice Demonstration for Home Health Services.” CMS believes this demonstration “will assist in developing improved procedures for the identification, investigation and prosecution of Medicare fraud occurring among home health care agencies providing services to Medicare beneficiaries.” Illinois, Ohio, North Carolina, Florida and Texas, with the option to expand to other states in the Palmetto/JM jurisdiction, are the initial targets for the demonstration.

Home_Health_Pre_Claim_Review


Home health agencies may choose a pre-claim review, post payment review or minimal post payment review with a 25% payment reduction for all home health services. Once agencies reach a target affirmation or claim approval rate, the agency may decide to be removed from the demonstration and only be subjected to spot checks.

The revised claim review will not delay the initiation of home health services, alter the Medicare home health benefit or change the home health clinical documentation requirements. With the implementation of the revised demonstration, CMS believes provider compliance with the Medicare regulations will improve and improper payments will decline.

CMS is taking comments through July 30, 2018.  Please click on the link below to post a comment.

https://www.federalregister.gov/documents/2018/05/31/2018-11492/agency-information-collection-activities-proposed-collection-comment-request

Don't wait to have CMS review your claims. LW Consulting, Inc. can perform a chart audit and provide your organization with feedback related to Medicare rules and regulatory compliance.

Please email Patty Klinefelter at pklinefelter@lw-consult.com or call 540-686-1311 to schedule a chart audit.