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The Return of Pre-Claim Review - What We Know

**Update - December 12, 2018: RCD did not launch in Illinois on December 10th. Providers are still waiting for CMS to open the RCD portal so they can make their choice between pre-claim review, post-payment review, or a limited review with a 25% payment reduction. 

In 2016, CMS began rolling out a pilot program to enforce a more proactive oversight strategy on Medicare home health claims in an effort to reduce fraud and waste. The ultimate goal was to reduce improper payments and the cost of additional documentation and resources it takes for CMS to chase them. This "Pre-Claim Review" demonstration subjected home health agencies to additional billing scrutiny and red tape. 

How to Prepare for Pre-Claim Review

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

For providers who have yet to experience the Pre-Claim Review process, education and preparation are more crucial than ever. It's wise to ensure your staff and revenue cycle practices are fully equipped to handle any possible cash flow delay or drain on resources. Check out this short video outlining the most common Pre-Claim Review challenges and how eSolutions can assist in keeping your revenue cycle in the best shape possible.

Pre-Claim Review Demonstration Expanding to Florida

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice. 

The Pre-Claim Review Demonstration 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

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

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 Review?

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

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 pushed back to April 1, 2017 in Florida, and delayed in 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

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

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.

10 Things You Should Know About Pre-Claim Review

UPDATE (4/3/17): Pre-Claim Review has been paused in Illinois and delayed in the remaining states until further notice.

Most home health providers are becoming increasingly familar with the Pre-Claim Review Demonstration process. The demonstration has already begun in Illinois, and will soon start in Florida. The start dates for Texas, Michigan and Massachusetts are still unknown. 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: