The Centers for Medicare & Medicaid Services (CMS) is announcing that under the new program, home health agencies (HHAs) could choose to undergo either pre-claim or post-payment reviews, or to forgo reviews but take a 25% payment reduction on all claims submitted for home health services.
In the CMS memo issued Tuesday, CMS proposes to roll out the reviews in Illinois, Ohio, North Carolina, Florida and Texas, with the option to expand to other states under the jurisdiction of Medicare Administrative Contractor (MAC) Palmetto/JM. The effort is intended to ensure proper payments and flag any activity that could indicate Medicare fraud. The proposal will appear in the Federal Register in the coming days, at which point it will be subject to a 60-day public comment period. For more details see CMS Memo.