Blogs

This is very worrisome for our home health agency and I am sure just as troubling to all home health agencies across Texas and the nation.
I just read the blog that Rachel Hammon, RN, BSN posted, "The Pre-Claim Review Demo I Here; What It means and How it works. " In it she wrote "An Agency's performance during the recent Probe and Educate project should indicate how an agency will perform during the demonstration project." I do not believe that is an accurate indication at all. Unless CMS/Palmetto plan on denying 90%+ of these pre-review claims, like they have done with the Probe and Educate project. We have 4 out of 5 of our ADR's back and all 4 have been found to be lacking in one area or another. Here is the kicker; every document, statement, order, etc, that CMS has said was not included in the ADR documentation, clearly was included in the submitted paperwork. I have read countless comments in the forum here at TAHC&H that say the same thing.
How can HHA's survive, stay open, and continue to accept Medicare clients, when we do admit a patient, we have no idea if we will get paid. Although we may not have proof right now that all claims will be denied, one cannot help but think to these ADR's with the Probe and Educate Project is just a pre-cursor to the Pre-Claim Review, where all our claims will be denied and we will see the RAP's taken back and we will not received payment for services rendered.
Not only are we looking at lost income on Medicare episodes, we are looking at the need for an increase in office staff. We will need at least one more full time person, that is just dedicated to Pre-Claim Reviews. I do not see how the smaller HHA's can flourish and grow in the midst of this news.