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CMS Releases Early Statistics for Pre-Claim Review Demonstration in Illinois

Posted on Thursday, October 6, 2016 10:36 PM

Due to the continued focus on the Pre-Claim Review (PCR) Demonstration for home health services, CMS decided to release statistics for the state of Illinois.

According to the data, here are the following statistics for submission and review:
- About 91 percent of requests were submitted through the Medicare review contractor’s online portal over the first eight weeks
- About 99 percent of reviewers provided decisions within required timeframes during the first eight weeks

According to the data, here are the following statistics for provisional affirmation:
- Requests have been increasing with positive decisions over the first eight weeks
- 66% of the requests received a provisionally affirmed or partially affirmed decision as of week eight
- HHAs have the option to resubmit requests for an unlimited number of times

The reasons for non-affirmed decisions include the following:
- 25% skilled nursing services/therapy are not medically necessary or documented
- 18.6% of homebound status’ are not documented
- 5.6% of face-to-face are missing/incomplete
- 50.8% are recorded as other documentation errors - certifications, orders, signatures

Home health agencies continue to voice their concerns with the lack of education for the rollout in Illinois. However, Medicare Administrative Contractors (MACs) for Illinois have prepared the state with the following:
- Led 12 seminars
- Held 19 individual calls with providers
- Responded to 517 Provider Contact Center helpdesk support questions

For the five affected states, there has not been a set date on when the pre-claim review is expected to rollout again. However, CMS will provide at least 30 days’ notice.

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

For the full article, click here.

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