Prior Authorization Demonstration Plan

June 2016: CMS has unveiled it’s concept for prior authorization of home health care and confusion ensues. It will be a demonstration porcess first and the first state to start it by Aug. 1 is Illinois.  Texas, Florida, Michigan and Massachesets willl follow shortly after that. 

Agencies in these states will "be required to submit documentation for review before processing claims for services. The requirement comes as a result of a 59% improper payment rate among home health claims in 2015, according to CMS.” 

CMS says there will be no additional paperwork required, just that it needs to be submitted earlier in the process to avoid the current “pay and chase process” wherby agencies bill and are paid, and then CMS has to chase down repayment when services are deemed improper. 

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