CMS Proposes Prior Authorization Demonstration Project for Home Health
The Centers for Medicare and Medicaid Services is proposing to implement a Medicare demonstration project, which they believe will help assist in developing improved procedures for the identification, investigation, and prosecution of Medicare fraud occurring among Home Health Agencies (HHAs) providing services to Medicare beneficiaries. This demonstration would help assure that payments for home health services are appropriate before the claims are paid, thereby preventing fraud, waste, and abuse. As part of this demonstration, CMS proposes performing prior authorization before processing claims for home health services in: Florida, Texas, Illinois, Michigan, and Massachusetts. CMS would establish a prior authorization procedure