Home Health Pre-Claim Review Pilot: What the 5-Year Extension Means for Providers

At Advanced Revenue Cycle Management, we understand that keeping up with Medicare regulations is crucial to ensuring smooth and efficient operations. Recently, Medicare announced a five-year extension of the Home Health Pre-Claim Review Pilot, and this expansion has some key implications for providers.

What is the Home Health Pre-Claim Review Pilot?

The Home Health Pre-Claim Review Pilot was implemented by Medicare to determine the best course of action when approving Home Health services. The program explores whether it’s more effective to approve services before they’re provided or to verify the validity of services after they’ve been delivered. This pilot aims to ensure that patients receive the necessary care while protecting Medicare funds from fraud and unnecessary claims.

A Five-Year Extension

Initially, the pilot was scheduled to end on May 31, 2024. However, in a last-minute decision, Medicare extended the program for another five years. This extension gives providers more time to adjust to the requirements of pre-claim review. The decision also involved an expansion of the pilot to include additional states, ensuring more providers and patients will be affected by this policy moving forward.

What Does This Mean for Home Health Providers?

For providers, this means staying vigilant with documentation and ensuring all services are appropriately validated before submitting claims. It also means adapting to the changes that this extended and expanded pilot brings. ARCM is here to support you every step of the way, offering guidance and expertise in navigating these evolving regulations.

Partnering with ARCM

At ARCM, we’re dedicated to helping providers like you streamline your billing processes and maintain compliance with Medicare regulations. Reach out to us to learn more about how we can assist you during this extended pilot program and beyond. Together, we’ll ensure you’re well-prepared for the future.