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.

Medicare Improper Payment Rate for Home Health Services

percentages