What's the Latest on Pre-Claim Reviews?

Posted by Jesse Baguchinsky on Nov 2, 2016 11:00:00 AM


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?

PCRD requires home health providers in Illinois to submit pre-claim documentation that demonstrates eligibility to justify the delivery of home health services. The demonstration is meant to determine if pre-claim reviews will reduce expenditures while maintaining or improving quality of care. PCRD is also designed to assist with the prevention of fraud, waste and abuse.

A number of providers in Illinois have been experiencing confusion as to why some claims are being denied. Some providers are concerned that the demonstration could affect patient care.

While you may have heard talk of a delay, we recommend you prepare yourself the best that you can. We have plenty of resources available on PCRD, and if you have any additional questions you can contact us at (866) 633-4726, or fill out our form online


Topics: home health, CMS, pre-claim review