Leslie Dallas: Hold off on Medicare ‘pre-claim’ review

The federal Medicare agency recently began imposing a demonstration that requires third party contractors to approve physician-prescribed home healthcare for beneficiaries before Medicare will pay for the service. Home health leaders, physicians and patients have expressed concern that this policy could result in dangerous delays and denials for clinically necessary care, particularly for patients recently discharged from the hospital who are particularly vulnerable.

Since the program was implemented, home health agencies have reported problems navigating the so-called “pre-claim review” process, including care denials for patients following major joint replacements who need home health to safely transition from hospital to home.

While Medicare launched the program with the hopes of reducing fraudulent claims, there is little evidence that pre-claim review will be effective in rooting out bad actors from the Medicare program. Instead, compliant and quality home health agencies are subject to increased administrative requirements that mean more time with paperwork and less time with patients. More targeted solutions are needed to achieve Medicare’s goal, which I support.

Fortunately, bipartisan lawmakers in Congress have introduced the Pre-Claim Undermines Seniors’ Health (PUSH) Act of 2016. This much-needed legislation delays pre-claim review of home health services for one year to allow Congress, Medicare and home health stakeholders to work together to strengthen the program and improve education to ensure patient care is not delayed or unjustly denied.

I urge our state’s lawmakers in the U.S. House to cosponsor the PUSH Act to protect the timely delivery of care in the home setting patients prefer and physicians trust.

Leslie Dallas, PT, DPT

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