Since the Centers for Medicare & Medicaid Services (CMS) rolled out pre-claim review for home healthcare in Illinois, providers across the state have encountered numerous delays and technical problems. Across the home health community, weâ€™re already receiving reports of improper care denials from the Medicare Administrative Coordinators (MACs) that review Medicare home health claims. Several other providers have also reported issues using the MACâ€™s electronic submission system â€“ resulting in long wait times and unnecessarily delaying patient services.
Fortunately, there is a fix. Last week, Representatives Tom Price (R-GA) and Jim McGovern (D-MA) introduced bipartisan legislation to suspend and delay further extension of pre-claim review to other states so CMS can make adjustments to the program. The Pre-Claim Undermines Seniorâ€™s Health (PUSH) Act would implement an immediate, one-year delay to pre-claim review and require the Department of Health and Human Services to produce a report detailing the programâ€™s impact on patients, providers, and the Medicare system.
Specifically, the PUSH Act:
- Delays the application of the demonstration in each State so it does not apply to episodes of care beginning earlier than one year after the earliest date that the demonstration was scheduled to begin in each State;
- Calls on the Secretary to suspend the demonstration in a State for at least one year if the pre-claim review demonstration is underway at time of enactment. This would extend the programâ€™s delay to Illinois, which is currently the only state in which this program was implemented.; and
- Calls for a report to Congress no later than six months after the date of enactment to, among other things, analyze the impact of Medicare pre-claim review in any State in which it was implemented, describe the resources provided to physicians and home health agencies to conduct the demonstration, and outline alternative measures to identify improper payments with possible corrective actions
You can help protect vulnerable seniors who depend on home health seniors by emailing your Congressperson today and asking him or her to support this bill! Click below to get started: