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.
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?
As most home health providers know, CMS is implementing a three-year Medicare Pre-Claim Review Demonstration in Illinois, Florida, Texas, Michigan, and Massachusetts. This process requires all home health providers to submit pre-claim documentation for review before submitting the final claim. Earlier this week, CMS announced that this demonstration will be delayed in Florida.
Most home health providers are becoming increasingly familar with the pre-claim review process demonstration. This test has already begun in Illinois, and will soon start in Florida, Texas, Michigan and Massachusetts. This process requires providers to submit pre-claim documentation that demonstrates eligibility to justify the delivery of home health services. This has been troubling news for many home health agencies because of the additional payment penalties, and the possibility of needing additional staff and training for submitting and tracking these documents in a timely manner. We want to help make this transition as easy as possible, so here are ten pre-claim review items everyone in home health needs to know:
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