FutureFocus June 6, 2018: Pre-Claim Review Demo Re-Start - What You Need to Know

Lisa Remington

News permeated the industry as notice of the pre-claim review demonstration is restarting and expanding. The demonstration will impact 1.3 million claims each year. Of interest to our readers is the report issued by the congressional watchdog agency, the General Accounting Office (GAO). CMS wants to identify new opportunities for expanding prior authorizations for additional items and services with high unnecessary utilization and high improper payment rates. The CMS asked for public input on how it can ensure the new experiment doesn't harm access to care. Comments are due July 31.

Lisa Remington, President, Remington Health Strategy Group

By: Ronald M. Schwartz, Writer, The Remington Report

The Centers for Medicare & Medicaid Services (CMS) plans to restart its pre-claim review demonstration, claiming it will be much improved from the controversial program the agency put on hold over a year ago. CMS proposes implementing the demonstration in Illinois, Ohio, North Carolina, Florida and Texas, with the option to expand to other states. The demonstration will impact 1.3 million claims each year.

By: Ronald M. Schwartz, Writer, The Remington Report

Since September 2012, the Centers for Medicare & Medicaid Services has subjected selected Medicare items and services to prior authorization and pre-claim reviews. Now, the congressional watchdog agency, the Government Accountability Office GAO), wants CMS to continue such efforts and identify “new opportunities for expanding prior authorization to additional items and services with high unnecessary utilization and high improper payment rates.”

by: The Remington Report

In this week's trending news, we read about a new CEO appointment and the acquisition of an IT company.