REMINDER: Home Health Probe and Educate Round 2 to Begin Jan. 19

Beginning January 19 of 2017, all states will participate in the Home Health Probe and Educate Review Round 2, a review that determines if home health agencies (HHAs) meet the compliance requirements for certification or recertification, patient eligibility, payment criteria, coding and medical necessity, as outlined in CMS-1611-F. The Home Health Probe and Educate Review includes all states, except those actively involved in the Home Health Pre-Claim Review Demonstration.

A Guide to Choosing the Right Clearinghouse in 2017

An efficient revenue cycle solution is highly dependent on the quality of your company’s clearinghouse. First and foremost, in order to identify which clearinghouse is the best fit for your company, it’s important to recognize what your billing system may be lacking. Here are some key features
you should be on the lookout for.

Get Ready: CMS is Updating the Current Version OASIS-C1 to OASIS-C2

On January 1st, the OASIS-CR is going into effect. This will mean the addition of three new standardized items (M1028, M1060, GG0170c), along with modification to select medication and integumentary items. This is being done in an effort to standardize with other post-acute settings of care (M1311, M1313, M2001, M2003, and M2005).

Pre-Claim Review Demonstration Expanding to Florida

The Pre-Claim Review delay is coming to an end. On December 19th, CMS announced that the demonstration will expand to Florida on, or after April 1, 2017. Since the delay announcement, CMS and the Medicare Administrative Contractors (MACs) have provided education to home health providers on how to submit pre-claim review documentation, and will continue that process to ensure Florida is ready.

Pre-Claim Review Update

On December 2nd, the Centers for Medicare & Medicaid Services reported that Pre-Claim Review Demonstration affirmation rates had hit a high of 87% in the state of Illinois. While 83% of these requests were fully affirmed, another 4% received a partially affirmed decision. This is welcome news to providers who saw only a 66% affirmation rate during the first eight weeks of the program.

Be Prepared for RAC Audits

Healthcare providers are no strangers to the RAC (Recovery Audit Contractor) audit program. Since 2009, the Centers for Medicare & Medicaid Services (CMS) has awarded contracts to private companies to review Medicare claims and recover potential overpayments. We’ve all recently had a welcome break from RAC audits, but that’s about to change. Last month, CMS awarded new contracts to several companies, and a new wave of audits is set to begin as early as January!

10 More Holiday Gift Ideas for the Healthcare Professional in Your Life

The gift giving season is officially here. In addition to assisting with your claims management, we also want to try and make your holiday season a little less stressful by providing some unique gift ideas for the healthcare professional, or professionals in your life. So whether you want to show appreciation for your employees, got roped into a Secret Santa, or even if you're a patient who stumbled upon this post, you're sure to find something good.

Transition of Care eBook

We have a new eBook available in our resource library. This eBook will walk you through Transition of Care and give you some best practices on how to streamline your process. 

What's the Latest on Pre-Claim Reviews?

The Pre-Claim Review Demonstration (PCRD) that began in Illinois back in August is off to a less than ideal start. Because of this, the demonstration has been delayed in Florida, Texas, Michigan and Massachusetts until further notice. What does this mean for you, and how can you best prepare for PCRD?

ClaimRemedi October Newsletter


Product Updates


Removing Claim Files

An enhancement was made to ClaimRemedi to allow the removal of claim files. The users can select multiple files using the Control button and then selecting the Trash Can icon in the upper right-hand corner.