Today, Friday, March 31, 2017, the Center for Medicare and Medicaid Services (CMS) posted a notice that they have paused Pre-Claim Review (PCR) for Illinois for 30 days and will not move forward in FL on April 1. We will continue to keep you updated on what the Health and Human Services (HHS) and CMS plans to do next. We have been working in a coalition of the five demonstration states and with the national associations to bring this demonstration to a close. Our last letter was sent to Dr. Price, just this week. Click here to read.
HHS and CMS are looking at other alternatives to PCR and have committed to continue to work with the industry to find better solutions to Fraud and Abuse and TAHC&H, as always, will be there taking your message forward. In the coming weeks, CMS intends to look at a new approach. TAHC&H has made public comment on what a targeted approach to Fraud and Abuse would look like in the context of PCR. In discussions with CMS officials, they are seeking input on alternatives to a broad implementation of PCR.
That said, this is a testament to all the advocacy work you as TAHC&H members have done in calling and writing your legislators about this issue and making the visits necessary to educate congress on the issue. Very good work; and thank you TAHC&H members for your passion and commitment to home health and your patients!
Pre-Claim Review Demonstration for Home Health Services
03/31 Updates
As of April 1, 2017, the Pre-Claim Review demonstration will be paused for at least 30 days in Illinois. The demonstration will not expand to Florida on April 1, 2017.
After March 31, 2017, and continuing throughout the pause, the Medicare Administrative Contractors will not accept any Pre-Claim Review requests. During the pause, home health claims can be submitted for payment and will be paid under normal claim processing rules. CMS will notify providers at least 30 days in advance via an update to this website of further developments related to the demonstration.