To date TAHC&H members have sent 2415 emails/faxes or letters and made 153 calls to their members of Congress on Pre-Claim review. You are making a difference so continue to contact your Members of Congress. Bipartisan Members in Texas share your frustration and we need them to continue to be aware and stay engaged on stopping pre-claim before it starts in Texas.
Take action today to protect home health from pre-claim review!
As we have reported in past posts, the Medicare Pre-Claim review process that was initiated in Illinois on August 3rd is a disaster. As reported, TAHC&H attended a chat forum with the National Association for Home Care & Hospice and the Illinois Homecare & Hospice Council. The call revealed a litany of problems, from lost documentation by Palmetto GBA, to difficulties in submitting documents electronically and delays in initiating care. Agencies report it takes as much as an hour to submit the documentation required for each pre-claim review.
Most alarmingly, agencies report rejection rates as high as 80%, mainly on the grounds that the PGBA reviewers determine that the patient is not homebound or that the care is not medically necessary. Agency leaders who participated in a chat forum sponsored by NAHC and IHHC reported they may be forced to wait to admit patients to care until they receive a favorable pre-claim review decision. NAHC warns that access to care problems will escalate in the very short term unless CMS and PGBA correct the problems with the project quickly.
TAHC&H is keeping our Congressional delegation appraised of the problems in IL. Just today, we had an opportunity to discuss the issue with Congressman Cuellar and what he might be able to do from an appropriations standpoint (see FB Page). We have also approached Representative Culberson, ranking member on the House Appropriations Committee about an appropriations approach to stop this demonstration. Additionally, we are working with Dr. Burgess’s office, who will meet with CMS after Labor Day on this issue.
It is super important for all TAHC&H members to keep talking to your members of congress. If you know of colleagues in your area who are not members of TAHC&H, share this post with them and encourage them to join TAHC&H and join your efforts to stop this demonstration from starting in Texas; together we are stronger and we all make a difference! You can visit our Pre-Claim review web-page for talking points and information about PCR all in one location. We will continue to inform you of the Illinois provider experience so that you can communicate that to your legislators.
Additionally, we are providing Pre-Claim Review education in partnership with Palmetto GBA and CGS across Texas. Be sure to register early to ensure a spot.