Home Health & Hospice Week

MAC readies Florida education sessions.

Home health agencies and their representatives are hoping they may see some relief from PCR from the incoming Trump administration (see Eli’s HCW, Vol. XXV, No. 41). The National Association for Home Care & Hospice lists PCR as one of the “inappropriate regulations” it hopes to see Trump administration officials eliminate.

PCR is ripe for elimination due to its many, many serious flaws, NAHC contends in its member newsletter, including:

For Home Health Agencies: Non-affirmations given with no reasons; non-affirmations for obvious cases such as physical therapy for total knee replacements; and “a time-consuming and burdensome paperwork process that often requires at least one hour for a single claim — in contrast to the [Cen-ters for Medicare & Medicaid Services] promise that the process would take mere minutes;” and major cash flow problems. “Many of the reviewers are new and really don’t get it,” laments Rebecca Friedman Zuber.

For Beneficiaries: Confusing letters of non-affirmation that scare them away from using home care and shifting care out of their homes despite their stated preference for receiving physican-ordered care in the home.

For the Medicare Program: Rising costs as patients shift from home care to hospitals and other institutional care settings and no significant benefit for a hefty cost.

“At least one Illinois HHA has closed due to PCR and others may soon follow,” NAHC warns. PCR “has created chaos in the home health industry in that state.”

And “Pre-Claim Review has been such a failure that there are many other reasons we could cite for ending the demonstration now and never allowing it to spread to other states,” the trade group argues. But spreading PCR to other states is just what the CMS and its contractors are preparing for.

HHH Medicare Administrative Contractor Palmetto GBA is moving ahead with in-person PCR education for HHAs in Florida next month, it says on its website. It will hold PCR documentation requirement sessions in Ft. Lauderdale on Dec. 8 and Orlando on Dec. 9.

Neither CMS nor MAC officials are divulging when the program will resume implementation in the other four demo states.

As a last resort, NAHC has indicated it will file a lawsuit to stop the demo (see Eli’s HCW, Vol. XXV, No. 39-40). But the trade group has yet to take action on the threat.