Healthcare Provider Solutions

The initiatives to stop Medicare Fraud and Abuse are becoming more numerous and cumbersome. How much more are agencies going to be able to endure?  The most recent is the announcement of the possible implementation of a Prior Authorization Demonstration Project for Medicare home health services.  This demonstration would be limited to the states of Texas, Florida, Michigan, Illinois and Massachusetts, at this time.  The Notice from CMS was issued on 02/05/16 and has a 60 day comment period that ends on 04/05/16.

Summary of the Notice:  The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS’ intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (the PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information (including each proposed extension or reinstatement of an existing collection of information) and to allow 60 days for public comment on the proposed action. Interested persons are invited to send comments regarding our burden estimates or any other aspect of this collection of information, including any of the following subjects: (1) The necessity and utility of the proposed information collection for the proper performance of the agency’s functions; (2) the accuracy of the estimated burden; (3) ways to enhance the quality, utility, and clarity of the information to be collected; and (4) the use of automated collection techniques or other forms of information technology to minimize the information collection burden.

Following is the link to the summary and instructions for commenting:

https://www.federalregister.gov/articles/2016/02/05/2016-02277/agency-information-collection-activities-proposed-collection-comment-request#h-9

Agencies must speak up as to the burden this is going to cause.  Comments should include the challenges that agencies already deal with in trying to get authorizations from other payers to ensure the care that the patients need can be provided. Agencies should be clear as to how this will restrict care and the excessive cost that agencies will incur in implementing this.