Review Choice Demonstration is proudly presented to you by National Association for Home Care & Hospice. Thank you. We hope that you enjoy your course.
CMS has revised prior authorization to, in their words, offer more flexibility and choice for providers in the five states (Illinois, Ohio, North Carolina, Florida and Texas) required to provide information supporting the care provided to home health patients. CMS notes three options – a Pre-Claim review that allows for unlimited resubmissions of non-affirmed requests, post-payment review of all claims (which is the default option), or minimal review with a 25 percent payment reduction – and the specifics of these options will be reviewed in detail. This session will also review the subsequent options (Selective Post-Payment review or Spot Check) for those choosing either of the first two options with a greater than 90 percent affirmation rate. It will review the outcomes of the Pre-Claim Review demonstration in Illinois and provide the attendee with the tools and resources to be able to identify the best option for their agency, should they be in one of the five states (or should CMS expand the demonstration).
Faculty:
Wayne Van Halem, CFE, AHFI
Robin Seidman, RN, BSN, MSN, MBA, LNCC