VNAA Submits Comment Letter on Pre-Claim Review Demonstration
Monday, July 25, 2016
by: Visiting Nurse Associations of America

Section: Public Policy and Advocacy

On July 21, VNAA commented on the notice titled Agency Information Collection Activities: Submission for OMB Review; Comment Request. This notice was published by the Centers for Medicare & Medicaid Services (CMS) in the Federal Register on July 12, regarding the Pre-Claim Review Demonstration for Home Health Services. VNAA is concerned and frustrated surrounding the newly named Pre-Claim Review Demonstration Proposal for Home Health Services.
CMS justified the implementation of the Pre-Claim Review Demonstration based on the Paperwork Reduction Act (PRA) notice stating “extensive evidence of fraud and abuse in the Medicare home health program.” VNAA supports a wide range of policies and efforts to combat fraud, as stated in the comment letter. The letter also identifies that the improper payments by home health agencies do not fall under what is characterized as home health fraud.

Dr. Shantanu Agrawal, Deputy Administrator and Director of the CMS’ Medicare Integrity Program Office, stated in his May 24, 2016, testimony before the U.S. House of Representatives Committee on Energy and Commerce that the majority of the 59 percent of improper payments were because of poor or incomplete documentation. The increase in documentation errors resulted from the implementation of the Medicare Home Health Face-to-Face Requirement, a program run by CMS with no specific documentation requirements.
VNAA is concerned that the Pre-Claim Review Demonstration will increase the risk of home health services being denied payment as a result of poorly-implement and inconsistently applied documentation requirements. This demonstration targets all providers and puts an unnecessary disproportionate burden on good actors. VNAA also expresses frustration that nothing in the Pre-Claim process will stop bad actors from submitting falsified claims as the programs have no mechanism to identify bad actors. 
The Pre-Claim Review Demonstration is scheduled to begin in Illinois on August 1, 2016. It is more important now than ever that CMS quickly develop, clarify and implement responses to the questions raised in the comment letter, regarding the qualifications of those participating in the demonstration (i.e. the Medicare Administrative Contractors) and whether or not changes will be made to the Demonstration after its implementation, based on its success.  

As VNAA waits for a response for CMS, work will continue to combat waste and fraud in home health services, while ensuring that VNAA member organizations do not suffer from policies that will jeopardize patient access to quality home healthcare. 
CMS still plans on implementing this program in the following five states on these dates:
  • Illinois beginning August 1, 2016
  • Florida no earlier than October 1,2016
  • Texas no earlier than December 1, 2016
  • Michigan and Massachusetts no earlier than January 1, 2017

Read the comment letter.
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