Pre-Claim Review Demonstration

CMS Pre-Claim Review Demonstration for Home Health Services in Florida and Other States Delayed

The Center for Medicare and Medicaid Services (CMS) has announced its decision to delay its Pre-Claim Review Demonstration in Florida. CMS came up with a decision to delay the next roll out in Florida after it received a not so favorable outcome in terms of procedural concerns during its implementation in Illinois on August 3, 2016.  

 

It can be recalled that CMS has scheduled Pre-Claim Review Demonstration in five States, namely, Illinois in August, Florida in October, Texas in November, Michigan and Massachusetts in January 2017, respectively.  CMS goal for the Pre-Claim Review Demonstration among this five states is to test whether pre-claim review improves methods for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHAs) providing services to people with Medicare benefits.  Also, CMS is also testing whether the demonstration helps reduce expenditures while maintaining or improving quality of care.   

 

Based on what happened in Illinois, CMS believes that an additional educational effort is required prior to initiating the demonstration in Florida.  This educational effort will focus on how to submit pre-claim review requests, documentation requirements, and common reasons for non-affirmation. CMS views these efforts as crucial to the long-term success of the demonstration for beneficiaries, providers, and the Medicare program.

 

The start dates for Florida, Texas, Michigan, and Massachusetts is yet to be announced; but, CMS will provide at least 30 days’ notice on this website prior to beginning in any state.

 

Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Overview.html