Progress | Impact
Stand Out & Deliver
In May 2016, CMS approved Palmetto GBA to pilot a Home Health Pre-Claim Review demonstration project to conduct pre-claim medical review of all home health claims in Illinois, Texas and Florida as an augmentation to Palmetto’s Jurisdiction M A/B MAC contract.
Palmetto GBA successfully
- completed program start up in 73 days, including recruitment and staffing of more than 430 employees, developing necessary work processes, and implementing innovative technology to support the initiative
- conducted extensive provider outreach and education
- developed innovative approach to the submission of medical documentation via eServices portal
Why a pilot program?
There is extensive evidence of fraud and abuse in the Medicare home health program, particularly in Illinois, Texas and Florida.