CMS recently proposed two groundbreaking demonstration pilot programs
aimed at reducing fraudulent and abusive practices occurring among Home
Health agencies providing services to Medicare beneficiaries. A
proposed FRAUD MEASUREMENT pilot would establish a baseline estimate of
probable fraud in payments for Home Health care services in the
fee-for-service Medicare program. In addition, a proposed PRIOR
AUTHORIZATION pilot process would require the submission of a
pre-authorization request for an approval determination that would be
applied before processing a Home Health claim.
These programs focus on areas of Home Health production and delivery for
PPS compliance and integrity. The Fraud Measurement Program collects
info from Home Health agencies, referring physicians and Medicare
beneficiaries, along with a historical billing summary of the agencies
involved, to estimate the percentage of fraudulent payments. For the
Prior Authorization proposal, a Home Health referral prompts the
submission of an authorization request to proceed with approved
For further insight into how these programs will change Home Health
delivery, this progressive presentation will outline the how's and why's
of the new programs, and identify areas of your care you will want to
review as you prepare for these new fraud-fighting models.
1. Identify recent CMS Fraud-Fighting Program Proposals for Home Health
2. Outline areas of Home Health focus for the new CMS programs
3. Propose care protocols that protect HH agencies from exposure under these new programs
Faculty: Arnie Cisneros, PT, President, Home Health Strategic Management
Need a copy of your Continuing Education Certificate?
Have an education topic you want us to research?
Interested in presenting for a TAHC&H Webinar or Live Conference?
Texas Association for Home Care and Hospice
3737 Executive Center Drive, Suite 268
Austin, TX 78731
© 2017 Texas Association for Home Care & Hospice
Site Design by eConverse Social Media and Powered by Higher Logic