HCAF: CMS Fraud-Reducing Efforts Coming to Home Health (SN, OT, ST - 1.5)

1 module


Course Length
90 mins

Andrei Gustilo



CMS recently proposed two groundbreaking demonstration pilot programs aimed at reducing fraudulent and abusive practices occurring among Home Health agencies providing services to Medicare beneficiaries. A proposed FRAUD MEASUREMENT pilot would establish a baseline estimate of probable fraud in payments for Home Health care services in the fee-for-service Medicare program. In addition, a proposed PRIOR AUTHORIZATION pilot process would require the submission of a pre-authorization request for an approval determination that would be applied before processing a Home Health claim. These programs focus on areas of Home Health production and delivery for PPS compliance and integrity. The Fraud Measurement Program collects info from Home Health agencies, referring physicians and Medicare beneficiaries, along with a historical billing summary of the agencies involved, to estimate the percentage of fraudulent payments. For the Prior Authorization proposal, a Home Health referral prompts the submission of an authorization request to proceed with approved programming. For further insight into how these programs will change Home Health delivery, this progressive presentation will outline the how’s and why’s of the new programs, and identify areas of your care you will want to review as you prepare for these new fraud-fighting models.

Course Instructor - Arnie Cisneros


Participants will:

1) Identify recent CMS Fraud-Fighting Program Proposals for Home Health

2) Outline areas of Home Health focus for the new CMS programs

3) Propose care protocols that protect HH agencies from exposure under these new programs


By completing/passing this course, you will attain the certificate HCAF Course Certificate

Learning Credits

CMS Fraud-Reducing Efforts Coming to Home Health
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