GAO Report Recommends Resumption of the Pre-Claim Review Demonstration

In a recent report focusing on the potential cost savings from prior authorization for medical services and devices, the GAO recommends the resumption of the highly criticized Pre-Claim Review Demonstration (PCRD).  

PCRD was started in Illinois to reduce and prevent waste, fraud, and abuse of Medicare home health.  Instead, as ElevatingHOME and VNAA stated, it caused administrative costs, slowed payments, and inconsistent reviews by the Medicare Administrative Contractors. PCRD was so problematic that a significant number of House and Senate members wrote the CMS asking to end PCRD. CMS has suspended the demonstration indefinitely.

As further evidence to inappropriateness of prior-authorization for home health, major insurance companies such as UnitedHealthcare, who have had prior authorization for services under Medicare Advantage, have eliminated prior authorization in all states except Texas.

ElevatingHOME and VNAA will continue to advocate against the resumption of PCRD.

Please contact Joy Cameron with questions.