The Patient-Driven Groupings Model (PDGM) has dominated the home health industry’s regulatory conversations of late, which is understandable, as it’s likely the biggest policy shift from the Centers for Medicare & Medicaid Services (CMS) in the past few decades.
There are several other regulatory items flying under the radar, however, including the potential reincarnation of the widely decried pre-claim review demonstration.
The home care space also faces significant regulatory change, including in the implementation of the electronic visit verification (EVV) requirement, which was mandated by the 21st Century Cures Act for 2019 but has since been delayed.
CMS announced updates to its revised pre-claim review proposal, intended to reduce Medicare fraud and improper claims, last week. The agency then followed up that news with EVV-related updates on Friday.
First revealed in May, the new pre-claim iteration targets Illinois, Ohio, North Carolina, Texas and Florida. It’s similar to the controversial roll out of pre-claim review from 2016, but with some differences.
Unlike CMS’ 2016 pre-claim test, for example, the new version gives home health agencies the option to forgo prior authorization in favor of post-payment review. Both models let providers completely opt out of the process, as long as they agree to take a 25% reduction on all payments for claims submitted. Under the new version, home health agencies with high claims approval rates could skip full review and only take part in a spot-check to ensure continued compliance.
At a basic level, EVV requires home care providers to verify type, date, location and duration of a home care service provided through the use of mobile applications and other methods.
Comment window expanded, start date identified
CMS announced last week it hopes to launch the demonstration in Illinois on December 10 of this year.
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