Yesterday, the federal district court issued a victory for the National Association for Home Care & Hospice (NAHC) and the home health agencies, Medicare participating physicians, caregivers, and beneficiaries it represents. The U.S. District Court for the District of Columbia declared that it has the power to hear a challenge to the validity of a Medicare rule that requires physicians to provide a narrative explaining why the patient meets Medicare coverage standards for home health services. The court issued the order to deny Medicare’s effort to have the lawsuit dismissed by the court.
The court also granted dismissal of two additional claims in the lawsuit. NAHC challenged the ambiguity of the interpretive guidance issued by CMS along with its failure to waive the recoupment of alleged overpayments under the Medicare “without fault” provision. The court found that the factual complexities warranted a review of individual claims determinations at the administrative levels prior any judicial intervention.
NAHC and Medicare are now moving forward with the lawsuit. If the lawsuit is successful, Medicare will be required to reopen and pay any claim previously denied for an insufficient narrative and stop any further claim reviews related to the narrative requirement. NAHC has urged home health agencies to consider appealing any narrative-related claim denials while the lawsuit is progressing. This will give agencies the opportunity to have the claims reviewed by the Administrative Law Judges and will also allow for easy identification of claims that may be subject to reopening if the lawsuit is successful.
*Information provided by NAHC.