NAHC Provides Update on Pre-Claim Review Demonstration, Model Letter of Information to Physicians
July 28, 2016 12:45 PM
The National Association for Home Care & Hospice (NAHC) continues working to stop or change the pre-claim review project, while taking steps to prepare for it as well. For your reference, NAHC is providing a model notice to physicians that agencies can use to explain what is happening to physicians who refer to home health. This article is primarily intended for home health agencies in the five states targeted for Medicare home health pre-claim reviews (Illinois, Florida, Texas, Michigan and Massachusetts). However, there may be interest in this topic in other states as well.
NAHC’s logo has been included on the draft letter, and NAHC suggests you add your agency’s identifying information as well. This might help get the message across to physicians that the agencies are not the party to blame for their increase in paperwork.
NAHC has not drafted a patient notice as the impact on individual patients is speculative and likely to vary greatly. Also, NAHC does not want to create patient anxiety or fear needlessly.
Beyond this draft letter to physicians, NAHC has instituted an information collection effort that will be unveiled shortly in Illinois as a starting point. The information is intended to gives us a real time “before and after” understanding of the impact of pre-claim review on resource use, billing and payment timing, patient acceptance and discharge, cash flow, and the outcome of pre-claim review requests. The data collection tool should be available shortly and NAHC will share it with you then. At this point, a number of Illinois HHAs have agreed to participate.
NAHC staff recently met with the heads of Medicare Program Integrity and Chronic Care Policy. CMS listened to NAHC’s ideas, but remained committed to moving forward with pre-claim reviews, at least in Illinois. The experience there will dictate whether anything changes in the other states. NAHC made several recommendations on how to scale the project back so the workload is more reasonable. CMS seemed to like the ideas, but only as fallback actions if they find they cannot meet the workload of reviews.
While some members of Congress want to help, the national party conventions and Congressional recess have detoured their doing so. NAHC is encouraging Congress to act very soon. However, CMS continues to rebuff the “soft” efforts from Congress on all fronts. CMS announced the start of hospital star ratings this week in spite of intense Congressional opposition, so the issue now requires legislation which is not an easily accessible option at this point.
A lawsuit is still an option but one NAHC wanted to hold off on while trying less aggressive approaches. The chances of success for a lawsuit would be improved by any facts indicating that the project has triggered harm following the August 1 start.
NAHC hopes the physician information letter is helpful to agencies. If you have ideas on additional ways in which NAHC can be of assistance, please share them with NAHC’s staff. It does appear that some agencies have begun to accelerate their processes for getting the documents needed from physicians so that they can quickly submit them for review. This is definitely a key factor in making the project work better for the home health agency. Another key is getting favorable review decisions, which remains to be seen.
The model physician information letter is available here.