NAHC to File Lawsuit to Stop Pre-Claim Review Demonstration

The Empire strikes back? No wait National Association is striking back against the “failed” Pre-Claim Review Demonstration. Read more.


On October 25, the National Association for Home Care & Hospice (NAHC) announced that its board authorized a lawsuit against the Centers for Medicare and Medicaid Services (CMS) in connection with CMS’ Pre-Claim Review (PCR) Demonstration for Home Health Services. The National Association is striking back against the “failed” Pre-Claim Review Demonstration (PCRD) with a plan to file a lawsuit against the Centers for Medicare & Medicaid Services (CMS). The board of directors of the National Association for Homecare & Hospice (NAHC) has authorized a lawsuit against CMS, which the association says

“is currently ravaging our Illinois members and threatening to do the same across the country.”

The lawsuit likely will be filed within weeks and will seek an injunction to stop pre-claim in Illinois, William Dombi, NAHC’s vice president for law, told Home Health Care News.

CMS Announced Delay In PCRD

Five states were originally scheduled to participate in the demonstration, with Florida and Texas beginning this year after Illinois, followed by Michigan and Massachusetts in 2017. Six weeks after the demonstration started in Illinois on August 1st, CMS announced a delay in the rest of the states, subject to a 30-day notice to resume (Oakes, 2016).

CMS Stands Behind Data

While CMS delayed implementing the demonstration to the other four pilot states, the agency has made no moves to stop the model in Illinois. It appears likely, at this point, the demonstration will be implemented in the other pilot states in the future.

NAHC Strikes Back

NAHC has been extremely vocal that the demonstration is harmful to the home health care industry, causing punishing administrative burdens and delaying care in Illinois. Home health providers across the country and in Illinois have also spoken up about their concerns over the demonstration, with one provider calling it the “worst regulation” he has ever seen. Agencies have also voiced their discontent with CMS (Baxter, 2016).

Whether your agency is for or against Pre-Claim Review Select Data’s got your back. Coming in 2017, Select Data will be launching a series of services surrounding Pre-Claim Review and Pre-Rap Review to empower your coding team with our tailored review services. Contact for more information.

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Need A Refresher On Pre-Claim Reveiw Demonstration? See Related article click here.

Baxter, A. (2016). NAHC to File Lawsuit to Stop Pre-Claim. Home Health Care News. Retrieved from:
Oakes, R. (2016). NAHC Considers Suit to Halt Pre-Claim Review Demonstration Project. McKesson Healthcare Talk. Retrieved from:

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