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CMS Announces Pre-Claim Start Date for Florida

Posted on Tuesday, December 20, 2016 9:26 PM

The Centers for Medicare & Medicaid Services (CMS) has announced that the Pre-Claim Review Demonstration (PCRD) will officially develop into its second state, Florida. After several months of push back, the program will go into on April 1, 2017.

The model was designed to reach the following five states: Illinois, Florida, Texas, Massachusetts and Michigan.

The demonstration has been in effect for the state of Illinois since August 2016, with very mixed emotions and strong criticism from the home health industry.

The demonstration’s goal is to reduce improper payments by targeting the states with some of the highest rates of improper payments. In 2015, 59% of home health claims resulted in improper payment, according to CMS, with a large proportion of that due to insufficient documentation.

Additionally, the demonstration will ”help educate home health agencies on what documentation is required and encourage them to submit the correct documentation, while still allowing the home health agencies to begin providing services.”

As of December 2, 2016, the affirmation rates for pre-claim requests reached 87% for partial or full affirmations, according to CMS.

Once the program was rolled out to Illinois in August, the industry advocates decided to delay the implementation and lawmakers put together legislation that included a one-year moratorium on the program. Recently, the National Association for Home Care & Hospice (NAHC) said it intends to file a lawsuit against CMS to stop the demonstration.

There might still be some hope for advocates to put an end to this program with an in incoming Trump administration. President-elect Trump’s choice for Secretary of the Department of Health and Human Services (HHS), Rep. Tom Price (R-GA), is the lawmaker who introduced the bill to pause the demonstration.

Corridor offers a variety of services to help you navigate through the CMS requirements – including:
• Readiness Assessment
• Outsourced Services
• Documentation Review

Call Corridor today for help with Pre-Claim Review. 1-866-263-3795

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