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 … [Read more...] about New Version of Pre-Claim Review for Home Health Proposed by CMS
Presentation to the House Appropriations
Committee on Article II: Overview of Medicaid Cost Reporting for Long Term Services and Supports ProgramsMedicaid Rate Setting Methodologies •Methodologies vary based on type of service, whether service has a Medicare equivalent, federal law, and available data.• Acute Care (physicians, CORF/ORF, HHA, DME, medical supplies, SHARS, MAC)• Resource-based Fees: equal to Medicare Relative Value Unit (RVU) for the service multiplied by applicable Medicaid conversion factor.• Access-based Fees:• … [Read more...] about Presentation to the House Appropriations
