CMS Releases Pre-Claim Review Operational Guide and Updates FAQs
Tuesday, July 5, 2016
by: Visiting Nurse Associations of America

Section: Public Policy and Advocacy

As VNAA alerted members earlier last month, the Centers for Medicare and Medicaid Services (CMS) released its plans to move forward with prior authorization for home health services under the guise of pre-claim review. Last week, CMS released the Pre-Claim Review Demonstration for Home Health Services Operational Guide in advance of a second special Open Door Forum (ODF) on the topic.
According to CMS, the purpose of the guide “is to interpret and clarify the pre-claim review process for Medicare participating home health agencies (HHAs) when rendering home health services for Medicare beneficiaries.” CMS hopes this guide will advise providers on the process for submitting documents in support of the final claim. In addition to the operational guide, CMS has also made updates to its Pre-Claim Frequently Asked Questions document
VNAA remains disappointed in CMS’s decision to dismiss the comments and concerns of 122 Members of Congress and almost 250 different health care service providers -- physicians, hospitals, home health -- and pushed forward a prior authorization demonstration for home health care in five states. We will continue to actively engage on this issue and update our members with tools and information as they happen.

CMS plans to start the Pre-Claim Review demonstration in Illinois starting August 1. The other states will have all started the demonstration by January 2017.
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