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Sparta Community Hospital issued the following announcement on July 31.
On July 26, Illinois Homecare and Hospice Council (IHHC) President Cheryl Adams, administrator of At-Home Health Care of Sparta Community Hospital, and IHHC Immediate Past President, Sheila Guither, OSF Home Care Clinical Educator, shared Illinois agencies' pre-claim review experience with their Ohio colleagues to help them prep for Review Choice Demonstration.
Following the pause of the Pre-Claim Review Demonstration for Home Health Services on April 1, 2017, the Centers for Medicare & Medicaid Services (CMS) worked to revise the Demonstration to offer more flexibility and choice for providers, as well as risk-based changes to reward providers who show compliance with Medicare home health policies.
The proposed Review Choice Demonstration for Home Health Services will give providers in the demonstration states an initial choice of three options – pre-claim review, post-payment review, or minimal post-payment review with a 25% payment reduction for all home health services. A provider’s compliance with Medicare billing, coding, and coverage requirements determines the provider’s next steps under the Demonstration. CMS will implement the Demonstration for the Home Health and Hospice Medicare Administrative Contractor Jurisdiction M (Palmetto) providers operating in Illinois, Ohio, North Carolina, Florida, and Texas for five years, with the option to expand to other states in the Palmetto/JM Jurisdiction.
The revised Demonstration will assist in developing improved methods to identify, investigate, and prosecute potential fraud in order to protect the Medicare Trust Funds, potentially reduce the rate of improper payments, and improve provider compliance with Medicare rules and requirements. Through either pre-claim or post payment review, the Demonstration will help make sure that payments for home health services are appropriate.
Original source can be found here.
Source: Sparta Community Hospital
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