Home Health & Hospice Week

Will MAC be ready in 6 weeks?

Home health agencies in the five demonstration states have a lot of processes to figure out in a very short amount of time, with a tremendous amount of reimbursement hanging in the balance.

Illinois will be the first state to start the preclaim review demonstration for home health services on Aug. 1, with Florida following on Oct. 1, Texas on Dec. 1, and Michigan and Massachusetts Jan. 1.

The Centers for Medicare & Medicaid Services said in its June 14 special Open Door Forum that the individual HHH Medicare Administrative Contractors would set the forms and processes and conduct the provider education for the demo, and didn’t have any information for when that would start — even for Illinois providers that will start the demo in a month-and-a-half.

CMS will be issuing an operational manual for the demo shortly, a staffer said.

The official also promised to help educate physicians on their face-to-face documentation duties under the demo. But thus far, home health agencies have been extremely underwhelmed by CMS’s and the MACs’ educational efforts in this area.

MACs are supposed to provide outreach and education under the demo, notes finance expert Tom Boyd with Simione Healthcare Consultants in Rohnert Park, Calif. “How quickly can that be done before the start dates?” Boyd asks.

Illinois HHAs also need to know ASAP which documents will be required in the pre-claim review, says Chicago-based regulatory consultant Rebecca Friedman Zuber.

CMS’s question-and-answer set on the demo says only that “the pre-claim review request should include all documents and information that support medical necessity for the beneficiary needing the applicable level of Home Health Services. The Medicare Administrative Contractor websites provide more specific information for each state.”

In the forum, the CMS officials stayed similarly vague on the documentation requirements, and punted on a question about whether the plan of care must be signed before the pre-claim review.