tci Medicare Compliance & Reimbursement - 2016 Issue 12

Home Health Prior Authorization: CMS Springs An Unpleasant Surprise On HHAs

Beneficiaries of home healthcare could soon face access issues. The Centers for Medicare &Medicaid Services (CMS) wants you to provide service even while awaiting MAC’s decision on Request for Anticipated Payment (RAP). The agency has decided to ignore forceful disapproval from within the home health industry and set up an incredibly short timeline for its implementation plan of the home health prior authorization demonstration. The three-year demo, renamed the “Medicare Pre-Claim Review Demonstration for Home Health Service,” would start “no earlier than” Aug. 1, 2016 in Illinois, Oct. 1 in Florida, Dec. 1 in...

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