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CMS Provides Q&As Around Pre-Claim Pause

Posted on Thursday, April 13, 2017 7:46 PM

After CMS released the news about the pause on its pre-claim review demonstration in Illinois and to not expand the demo in Florida, CMS released Q&As about the status of the demo.

From the April 4 Q&As, one question asked, “What to do for claims if the agency already had submitted a pre-claim review (PCR) request and that request had been non-affirmed by the Medicare Administrative Contractor (MAC)?”

The answer was, “Effective April 1, 2017, MACs will cease reviewing PCR requests, including resubmissions of PCR requests,” CMS wrote. “MACs will process home health claims under normal claim processing rules, without regard to whether a PCR decision was made and/or a Unique Tracking Number (UTN) is included on the claim.”

During the Q&As, CMS also noted that they will work hard to consider making changes to improve the demo.

“CMS is considering a number of structural improvements in response to feedback received on the demonstration to date,” the federal Medicare agency wrote.

According to the federal Medicare agency, “It’s not clear exactly when CMS will stop the pause — the federal Medicare agency said it will notify providers at least 30 days in advance of further developments about the demo.”

“CMS does not have a timetable for further developments related to the demonstration and is exploring options to improve the program,” the federal Medicare agency wrote. “CMS will provide at least 30 days’ notice on its website prior to expanding the demonstration to (Florida) or any other state.”

Please see the April 11, 2017 article in the Home Health Line Edition.


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