Home Health & Hospice Week

So much for that 10-day timeline for PCR decisions.

Getting claims processed cleanly under the Review Choice Demonstration can be far from easy. Take note of two new glitches that can slow down or even block your claims.

Problem No. 1: “Many providers are seeing their Pre-Claim Review (PCR) decisions in a pending status beyond the expected 10 business day processing time for initial submissions,” RCD contractor Palmetto GBA says in a recent post to its website. “This is due to a delay in the [Unique Tracking Numbers] migrating to the Common Working File (CWF),” the HHH Medicare Administrative Contractor reports.

“Once the decision is rendered by the reviewer, the UTN is then being sent to the CWF where it is searching each region for the beneficiary and this process can take up to 14 days,” Palmetto explains. “Since this is happening at the CWF level, this is not something that is within the reviewer’s control.”

Nevertheless, “PCR decisions are still being rendered within the 10-business day timeframe for initial submissions and 20-business day timeframe for resubmissions,” Palmetto maintains.

Problem No. 2: “Providers under the Home Health Review Choice Demonstration (RCD) who are under a postpayment review option (Choice 2 or Choice 4) may have had their claims adjusted by a 32I type of bill claim. When these adjustments occurred, the patient’s status may have been changed to a discharge status when the status on the original claim was anything other than a discharge,” Palmetto GBA says in its Claims Payment Issues Log.

“As of January 1, 2022, providers are supposed to be submitting a one-time 32A [Notice of Admission] to open an election for a patient and from there would only need to submit final claims. With the 32I adjustments discharging patients, this causes the subsequent claims to return stating that there is no open election for the patient,” Palmetto describes.

The solution: “Palmetto GBA has resolved this issue for postpayment adjustments processed by Palmetto GBA from 4/19/22 forward. You may see some activity on your claims as we adjust them to correct patient status,” the MAC shares.

But for claims not yet corrected, “please do not submit a new NOA or take any claim action to work around this issue. Palmetto GBA will provide additional updates when available,” it says.