Legislation Introduced in Congress To Expedite Home Health Claims

Legislation | November 01, 2017 | by Peter Notarstefano

Congress is addressing the overwhelming backlog of denied home health claims on appeal.

The Home Health Documentation and Program Improvement Act of 2017 H.R. 2663 was introduced in the House of Representatives by Reps. Earl Blumenauer (D-OR) and Kenny Marchant (R-TX).

Congress is addressing the overwhelming backlog of denied home health claims on appeal. The Home Health Documentation and Program Improvement Act of 2017 H.R. 2663 was introduced in the House of Representatives by Reps. Earl Blumenauer (D-OR) and Kenny Marchant (R-TX) and the act will:

  • Direct CMS to consider the entire patient record, including the home health agency’s record, when determining claim status.
  • Remedy the backlog of the approximately 25,000 appealed claims. Authority would be granted to CMS to settle these cases instead of each claim being reviewed individually by an Administrative Law Judge.

The face-to-face encounter with a physician to certify the need for home health care led to  There are an estimated 25,000 improperly denied claims that have been appealed and are now stuck in an overwhelming backlog. Many of these claims were improperly denied, and would have been approved, but CMS stated that there was insufficient information to move forward on the claims.

LeadingAge thanks Reps. Earl Blumenauer (D-OR) and Kenny Marchant (R-TX) for introducing this important legislation. The bill was referred to the House Ways and Means and Energy and Commerce Committees for consideration. We encourage LeadingAge home health members to contact their Representatives to encourage them to support this legislation.