Home Health & Hospice Week

Avoid putting a target on your back, industry rep warns.

Choosing whether to participate in the Pre-Claim Review demonstration program for home health services, if it becomes optional, may seem like a no-brainer: No way.

But home health agencies may find they have good reasons to consider participation, expects Bobby Lolley with the Home Care Association of Florida.

The Centers for Medicare & Medicaid Services has informally floated the idea of making the program voluntary, trade groups report (see story, p. 106). That means the program could become “one that offers a carrot if a provider chooses to participate and a stick if they don’t,” Lolley warns.

The carrot: Revamped PCR may apply to only certain patients or diagnoses instead of all patients, Lolley says. And it may limit the time that a provider would have to participate in the program based upon their affirmation rate. In other words, “if they get their affirmation rate into the 90-plus percentile, they could come off the program, perhaps being subject to random audits after that,” he theorizes.

The stick: “We cannot forget the stick,” Lolley emphasizes. “Clearly a provider who opts not to

participate in PCR would be on a list, a list that undoubtedly would be shared with the RACs, ZPICs or could provide something to do for the hundreds of new nurse reviewers that the MACs have hired in preparation for PCR,” he warns. “If you are a provider in the state of Florida you would not want to be on that target list,” he exclaims.