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.

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?

Pre-Claim Review Demonstration Delayed in Florida

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.

eSolutions September Newsletter

Worried about Pre-Claim Review? We've got you covered.

If you’re a home health provider in Illinois, Florida, Texas, Michigan or Massachusetts, it’s likely that the CMS pre-claim review demonstration has been one of your chief concerns. In case you’ve missed out on our recent pre-claim review webinar series, we want to assure you that we’re committed to making these changes as painless as possible for you.

10 Things You Should Know About Pre-Claim Reviews

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: