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CMS Proposes to Begin Pre-Claim Review Choice Demonstration on December 10, 2018 in IL

Posted on Friday, September 28, 2018 6:58 PM

CMS has issued a second Paperwork Reduction Act (PRA) notice for public comment for the Home Health Pre-Claim Review Demonstration.  It is for a 30-day public comment period.

Initially, CMS plans to implement the demonstration in Illinois, Ohio, North Carolina, Florida and Texas.  CMS plans to begin on December 10, 2018 in Illinois.

Providers in these states can to either 100 percent pre-claim review or 100 percent post-claim payment review.  They will be subject to a review process until HHA reaches the claim approval rate.  Once reached, they can choose to be relieved from claim reviews.

Providers also have an option to opt out of 100 percent pre or post-claim review by completing services and submitting a claim for an automatic 25 percent reduction in reimbursement and potential review by the Recovery Audit Contractor.

Source: NAHC Report

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