CMS has announced a new three-year Medicare “pre-claim review” demonstration for home health services in five states — Illinois, Florida, Texas, Michigan, and Massachusetts  — with “high incidences of fraud and improper payments for these services.”  The pre-claim review demonstration requires currently-mandated documentation to be furnished to the Medicare Administrative Contractor (MAC) earlier in the claims payment process.  The initiative does not require the home health agencies (HHAs) to wait for a determination prior to furnishing services, however, nor does it modify the scope of the Medicare home health services benefit.  CMS expects this initiative to “bolster the efforts that CMS and its partners have taken in implementing a series of anti-fraud initiatives in these states,” such as the use of temporary moratoria on the enrollment of new home health providers in selected geographic areas.
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