Home Health & Hospice Week
PCR Request Must Come Before Final Claim, Q&A Says
Watch out for this deadline no-no under the Pre-Claim Review demonstration project. Florida home health agencies, which will go under PCR starting April 1, may want to pay close attention.
Question: “Is it OK to submit a PCR request at the same time or after I submit the final claim?” a home health agency asked Palmetto GBA in a recent Frequently Asked Question set about the program.
Answer: “No, once a final claim is submitted, the request for pre-claim review is not applicable,” Palmetto responds. “If a PCR request is submitted on the same day or after the final claim is submitted, the PCR request will be rejected or disregarded regardless if a PCR decision is issued.” That means you’ll have to respond to any Additional Documentation Requests generated by the claim.
Budget this time: “We recommend you submit your PCR request a minimum of 10 days before you plan to submit your final claim in order to avoid the ADR process and resulting 25 percent payment reduction,” Palmetto advises.
Home Health & Hospice Week
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PCR Request Must Come Before Final Claim, Q&A Says
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