NAHC to File Pre-Claim Review Lawsuit Against CMS

Update: On March 31, 2017, CMS announced that as of April 1, 2017, the Pre-Claim Review demonstration will be suspended for at least 30 days in Illinois. The demonstration will not expand to Florida on April 1, 2017.  CMS will notify providers at least 30 days in advance via an update to their website of further developments related to the demonstration. HEALTHCAREfirst will continue to monitor the status of the Pre-Claim Review Demonstration and provide updates as information is made available.

On October 23, 2016, NAHC announced at their Annual Meeting in Orlando, FL that they will be filing a lawsuit against CMS over the pre-claim review demonstration. Pre-claim review is currently being conducted in Illinois, however initiation of the program in other states has been delayed.

NAHC President, Val Halamandaris, stated that filing a lawsuit is a “last resort” for NAHC but said that he feels as though they have no other choice. He said he plans to lead a tour of Illinois to publicize the damage that pre-claim review has done to patients and providers in the the state. He encouraged NAHC members to band together to fight back against the “scourge of homecare.”

Tell us what you think! How do you feel about pre-claim review? Leave a comment below.

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  1. - March 15, 2017

    PCR will only denied clients the healthcare that is needed by denying claims. It is just another plot of CMS to recoup funds wasted on other programs. In the end, HHA will have to discharge clients when claims are denied. CMS should be sued and fined for this bogus act against HHAs and Medicare recipients!

  2. Diana Gallo - October 31, 2016

    I feel that the whole idea of pre-claim review is contrary to what everyone is doing in home health; improving outcomes; reducing costs; reducing hospitalizations. All this is going to do is prevent access for patients and cost the Medicare system more money.
    I think NAHC is right to do a law suit.

  3. Mary Griffin - October 27, 2016

    PCR is here in Illinois and is not going away. I propose that each of the 5 states selected be under PCR for 6 month intervals only. Illinois August 2016 through January 2017; Florida – February 2017 through July 2017; Texas August 2017 through January 2018; Massachusetts February 2018 through July 2018; and Michigan August 2018 through January 2019. This gives CMS 3 years of paperwork to assess and evaluate without undue duress to the Home Health Care Industry

  4. Rhett Sorensen - October 27, 2016

    I am not in favor

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