The coalition for home care providers, Partnership for Quality Home Healthcare, released a statement through a press release recently regarding the Center for Medicare and Medicaid Services (CMS) and their decision to pause their pre-claim review process. The ‘process’ would have required home care providers to get approval for doctor recommended in home care services through a third-part government contractor.
The goal of this initiative is to combat rampant fraud that has plagued the in home care industry for decades, costing taxpayers billions of dollars in unnecessary services. Home care support has also been open to fraud by some providers, including agencies, for billing for services that were either unnecessary or never provided.
As the federal government has been working to stem this level of fraud, this new pre-claim process was developed and was scheduled to be rolled out in a few test states April 1, 2017. However, CMS imposed a 30-day hold on this at that time in order to review the rollout and ensure home care agencies and other providers were ready to handle this change so that the elderly and disabled would be able to continue receiving the services they need.
The Partnership for Quality Home Healthcare commented about this latest updated. As noted in the PR Newswire release, The Partnership for Quality Home Healthcare Applauds CMS for Halting Further Implementation of Pre-Claim Review Demonstration: Home health leaders advocate for program integrity reforms to reduce fraud without jeopardizing patient care:
“We are incredibly pleased CMS listened to the concerns expressed by bipartisan lawmakers and home health stakeholders, and suspended the application of the demonstration,” stated Keith Myers, Chairman for the Partnership for Quality Home Healthcare. “While the Partnership fully supports CMS’ intent to reduce waste, fraud and abuse within the Medicare home health benefit, the pre-claim review demonstration is not the right approach and we are grateful CMS has chosen to suspend the program while improvements are made, which we believe will be beneficial to providers, physicians and patients alike.”
As this new review process is on hold, it may provide an opportunity for CMS and home care agencies, caregivers, and others who have a vested interest in ensuring the system works and the people in need get the support they require to work together for a stronger, cost-effective solution.
According to the press release from Partnership for Quality Home Healthcare noted that there are an estimated 3.5 million people who receive some type of Medicare based home health benefit. This is also called a clinically advanced and cost-effective solution for those who may be unable to tend to their own care in a safe and healthy manner.
There was no word when this review process would be implemented in full.