Academic Journal
Pre-Claim Review And Traditional Medicare Home Health Spending: Evidence From 4 States.
| Title: | Pre-Claim Review And Traditional Medicare Home Health Spending: Evidence From 4 States. |
|---|---|
| Authors: | 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. |
| Source: | Health affairs (Project Hope) [Health Aff (Millwood)] 2026 Jun; Vol. 45 (6), pp. 692-699. |
| Publication Type: | Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't |
| Language: | English |
| Journal Info: | 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: Original Publication: Millwood, Va. : Project Hope, c1981- |
| MeSH Terms: | 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 |
| Abstract: | 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 |
| Database: | MEDLINE |
| ISSN: | 2694-233X |
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| DOI: | 10.1377/hlthaff.2025.01356 |