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Pre-Claim Review And Traditional Medicare Home Health Spending: Evidence From 4 States.

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Τίτλος: Pre-Claim Review And Traditional Medicare Home Health Spending: Evidence From 4 States.
Συγγραφείς: Marr J; Jeffrey Marr (jeffrey_marr@brown.edu), Brown University, Providence, Rhode Island., Meyers DJ; David J. Meyers, Brown University., Ryan AM; Andrew M. Ryan, Brown University.
Πηγή: Health affairs (Project Hope) [Health Aff (Millwood)] 2026 Jun; Vol. 45 (6), pp. 692-699.
Τύπος έκδοσης: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Project Hope Country of Publication: United States NLM ID: 8303128 Publication Model: Print Cited Medium: Internet ISSN: 2694-233X (Electronic) Linking ISSN: 02782715 NLM ISO Abbreviation: Health Aff (Millwood) Subsets: MEDLINE
Imprint Name(s): Publication: : Bethesda, MD : Project Hope
Original Publication: Millwood, Va. : Project Hope, c1981-
Ιατρικοί όροι (MeSH): Medicare*/economics , Health Expenditures*/statistics & numerical data , Home Care Services*/economics , Home Care Services*/statistics & numerical data , Insurance Claim Review*/statistics & numerical data, United States ; Humans ; North Carolina ; Centers for Medicare and Medicaid Services, U.S. ; Florida ; Ohio
Περίληψη: The Centers for Medicare and Medicaid Services (CMS) is increasingly experimenting with prior authorization in traditional Medicare. In 2016, CMS began using pre-claim review, a prior authorization-like system in which claims are reviewed after the service begins but before the claim is paid, for home health care in Illinois. Beginning in 2019, a modified demonstration program was also implemented in Florida, North Carolina, and Ohio. We studied the effect of pre-claim review on health care spending, using a synthetic control approach and Medicare claims data. Pre-claim review led to an immediate 13 percent decline in home health spending in Illinois, driven by declines in home health spending in Chicago and a decrease in the number of home health users in the state. Pre-claim review did not reduce spending in Florida, North Carolina, or Ohio. Our results suggest that pre-claim review can reduce health care spending in traditional Medicare, although effects may vary considerably across states.
Grant Information: U54 AG090084 United States AG NIA NIH HHS; Arnold Ventures
Entry Date(s): Date Created: 20260601 Date Completed: 20260604 Latest Revision: 20260726
Update Code: 20260726
PubMed Central ID: PMC13288217
DOI: 10.1377/hlthaff.2025.01356
PMID: 42224621
Βάση Δεδομένων: MEDLINE
FullText Text:
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PubType: Academic Journal
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  Data: Pre-Claim Review And Traditional Medicare Home Health Spending: Evidence From 4 States.
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  Data: <searchLink fieldCode="AU" term="%22Marr+J%22">Marr J</searchLink>; Jeffrey Marr (jeffrey_marr@brown.edu), Brown University, Providence, Rhode Island.<br /><searchLink fieldCode="AU" term="%22Meyers+DJ%22">Meyers DJ</searchLink>; David J. Meyers, Brown University.<br /><searchLink fieldCode="AU" term="%22Ryan+AM%22">Ryan AM</searchLink>; Andrew M. Ryan, Brown University.
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  Data: <searchLink fieldCode="JN" term="%228303128%22">Health affairs (Project Hope)</searchLink> [Health Aff (Millwood)] 2026 Jun; Vol. 45 (6), pp. 692-699.
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  Data: Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't
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  Data: English
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  Data: <i>Publisher: </i><searchLink fieldCode="PB" term="%22Project+Hope%22">Project Hope </searchLink><i>Country of Publication: </i>United States <i>NLM ID: </i>8303128 <i>Publication Model: </i>Print <i>Cited Medium: </i>Internet <i>ISSN: </i>2694-233X (Electronic) <i>Linking ISSN: </i><searchLink fieldCode="IS" term="%2202782715%22">02782715 </searchLink><i>NLM ISO Abbreviation: </i>Health Aff (Millwood) <i>Subsets: </i>MEDLINE
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  Data: <i>Publication</i>: <Mar./Apr. 1999-> : Bethesda, MD : Project Hope<br /><i>Original Publication</i>: Millwood, Va. : Project Hope, c1981-
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  Data: <searchLink fieldCode="MM" term="%22Medicare%22">Medicare*</searchLink>/<searchLink fieldCode="MM" term="%22Medicare+economics%22">economics</searchLink> <br /><searchLink fieldCode="MM" term="%22Health+Expenditures%22">Health Expenditures*</searchLink>/<searchLink fieldCode="MM" term="%22Health+Expenditures+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Home+Care+Services%22">Home Care Services*</searchLink>/<searchLink fieldCode="MM" term="%22Home+Care+Services+economics%22">economics</searchLink> <br /><searchLink fieldCode="MM" term="%22Home+Care+Services%22">Home Care Services*</searchLink>/<searchLink fieldCode="MM" term="%22Home+Care+Services+statistics+%26+numerical+data%22">statistics & numerical data</searchLink> <br /><searchLink fieldCode="MM" term="%22Insurance+Claim+Review%22">Insurance Claim Review*</searchLink>/<searchLink fieldCode="MM" term="%22Insurance+Claim+Review+statistics+%26+numerical+data%22">statistics & numerical data</searchLink><br /><searchLink fieldCode="MH" term="%22United+States%22">United States</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22North+Carolina%22">North Carolina</searchLink> ; <searchLink fieldCode="MH" term="%22Centers+for+Medicare+and+Medicaid+Services%2C+U%2ES%2E%22">Centers for Medicare and Medicaid Services, U.S.</searchLink> ; <searchLink fieldCode="MH" term="%22Florida%22">Florida</searchLink> ; <searchLink fieldCode="MH" term="%22Ohio%22">Ohio</searchLink>
– Name: Abstract
  Label: Abstract
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  Data: The Centers for Medicare and Medicaid Services (CMS) is increasingly experimenting with prior authorization in traditional Medicare. In 2016, CMS began using pre-claim review, a prior authorization-like system in which claims are reviewed after the service begins but before the claim is paid, for home health care in Illinois. Beginning in 2019, a modified demonstration program was also implemented in Florida, North Carolina, and Ohio. We studied the effect of pre-claim review on health care spending, using a synthetic control approach and Medicare claims data. Pre-claim review led to an immediate 13 percent decline in home health spending in Illinois, driven by declines in home health spending in Chicago and a decrease in the number of home health users in the state. Pre-claim review did not reduce spending in Florida, North Carolina, or Ohio. Our results suggest that pre-claim review can reduce health care spending in traditional Medicare, although effects may vary considerably across states.
– Name: GrantInfo
  Label: Grant Information
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  Data: U54 AG090084 United States AG NIA NIH HHS; Arnold Ventures
– Name: DateEntry
  Label: Entry Date(s)
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  Data: <i>Date Created: </i>20260601 <i>Date Completed: </i>20260604 <i>Latest Revision: </i>20260726
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  Data: 20260726
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  Data: PMC13288217
– Name: DOI
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  Data: 10.1377/hlthaff.2025.01356
– Name: AN
  Label: PMID
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  Data: 42224621
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42224621
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        Value: 10.1377/hlthaff.2025.01356
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        Text: English
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        Type: general
      – SubjectFull: Humans
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      – SubjectFull: North Carolina
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      – SubjectFull: Centers for Medicare and Medicaid Services, U.S.
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      – TitleFull: Pre-Claim Review And Traditional Medicare Home Health Spending: Evidence From 4 States.
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              Text: 2026 Jun
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