Medicare is rolling out a new program requiring bureaucratic permission to provide in home care services ordered by your Doctor! As part of a new ‘Pre-claim Review’ program being implemented state by state, Medicare is denying as much as 80% of the requested approvals for in home care ordered by physicians.
Listen in with our expert guests. Dr Garcia, Cardiologist and past President of the Texas Medical Association and Rachel Hammon, RN. Executive Director of the Texas Association for Home Care and Hospice as we learn the details of this disaster for our seniors!
Please contact your Congressman and tell them you want “Pre Claim Review for Home Health” STOPPED now! Don’t know who your Congressman is? Follow this link! Find My Congressman!
You need to learn the facts so you can help stop this disaster before your loved ones are denied essential care! This ‘Pre-claim Review’ review program will be coming to Texas December 1st if it isn’t stopped by Congress. We devote an entire special program to this massive reduction in patient health care.
Medicare Pre-Claim review for Home Health Care is being instituted over the objections of the Medical community. Medicare claims it is being done to combat fraud and abuse but it will do neither. The primary effect will be the destruction of the entire Medicare in home care system and removing patient’s access to what has been proven to be the most cost efficient means of keeping seniors healthy and independent at home.
Under this program, in spite of having the health care ordered by the patient’s physician, a government bureaucrat will decide if they think the patient ‘deserves’ in home care. Meanwhile the patient suffers. In addition, the program places huge new administrative burdens on the health care system but does not pay for them, so the money spent on meeting the paper shuffling requirements will be taken out of what should be spent on nurses and therapists caring for patients.
Four reasons why Pre-Claim Review is a bad idea;
1. PRE-CLAIM REVIEW will harm Medicare Patient’s access to care
Home health services are life sustaining, curative, rehabilitative, and palliative care. A prospective home health patient’s needs cannot be put on hold for 10-20 days without creating adverse effects to their health and well-being.
2. PRE-CLAIM REVIEW does not properly address the core problem of documentation that leads to the finding of “improper payments.”
Mediare readily recognizes that the vast majority of so-called “improper payments” are based on documentation errors or omissions. At a recent hearing before the House Energy and Commerce Committee, MEDICARE Director of Program Integrity Agrawal testified that the high incidence of so called “improper payments” is not due to fraud or abuse. Instead, it is due to minor clerical paperwork errors.
3. PRE-CLAIM REVIEW fails to target providers that are at high risk for fraud.
Rather than wasting significant time, expenditures and resources implementing a process that will not improve physician documentation or resolve fraud and abuse issues, MEDICARE should pursue agencies identified through analysis like that recently conducted by the HHS OIG published in the data brief entitled “Nationwide Analysis of Common Characteristics in OIG Home Health Fraud Cases.” Pursuing providers who meet already observed patterns of fraudulent behavior is a cost effective method more likely to address the issues of fraud in the home health industry in the US.
4. PRE-CLAIM REVIEW is inefficient and expensive, requiring extensive resources from MEDICARE and home health agencies.
The proposal is untargeted, with high administrative costs and operational burdens. It is likely to create improper barriers to access to timely care, would not be effective against the fraud concerns in Medicare home health services, and would not aid in achieving a higher degree of compliance with the alleged claim documentation deficiencies. It is unreasonable for MEDICARE to impose significant administrative burdens through pre-claim review prior determining the full nature of the documentation deficiencies and their root causes.
Contact your Congressman NOW to stop this. Find your Congressman’s contact information at http://www.fyi.legis.state.tx.us/Home.aspx
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