Bass, Berry & Sims attorney Danielle Sloane commented on Medicare’s decision to reinstate the review process for home-health claims before the claims are officially submitted for reimbursement. Although the review process places more administrative burden on providers, Medicare chose to revive the demonstration program to hopefully reduce high fraud and abuse in the home-health industry. Some providers are critical of the reinstatement, as Danielle points out, “If a Medicare contractor doesn’t have sufficient staff to timely review every single home-health agency claim, any home-health agency selecting pre-claim review would likely experience a significant payment delay. …The demonstration program seems to leave home-health providers with the unappetizing choice of reduced reimbursements for not participating or incurring major new administrative costs to submit records, withstand payment delays, and defend claims.”
The full article, “Medicare’s Home-Health Claims Review Back From the Dead,” was published in Bloomberg BNA Health Law Resource Center on May 30, 2018, and is available to subscribers online.