Home Health & Hospice Week

Illinois agencies improve affirmation rates.

Home health agencies in the next state to get hit with Pre-Claim Review, who think they can dodge the punishing scrutiny if they submit claims without tracking numbers, should think again.

So indicates one of the PCR questions-and-answers posted by HHH Medicare Administrative Contractor Palmetto GBA.

Question: “Will claims submitted during the first three months of the demonstration without a Unique Tracking Number (UTN) be subject to prepayment review?” one agency asked the MAC.

Answer: “Yes, if a PCR was not requested, all claims submitted without a UTN will be pulled for pre-payment review and the provider will receive an Additional Documentation Request (ADR) letter,” Palmetto explains in the PCR Q&A set. “If a PCR was requested and the claim is submitted without a UTN, it will Return to Provider (RTP) for correction.”

Tip: For electronic claims and the UB04, the UTN will follow the treatment authorization code in positions 1 through 18,” Palmetto also says in the Q&A. “You will key the UTN in positions 19 through 32.”

Another tip: “Do not put a space between the Treatment Authorization Code and the UTN,” Palmetto instructs. And “if you are using Direct Data Entry, enter the Treatment Authorization Code on Page 5 and the cursor will automatically go to the field to enter the UTN.”

Burden Still Crushing Land Of Lincoln Agencies

Meanwhile, Illinois HHAs are getting a handle on PCR requirements, although the program still places a massive burden on them.

The Centers for Medicare & Medicaid Services last posted PCR affirmation stats on its website Jan. 20. At that time, it reported an affirmation rate of 91.7 percent (including both full and partial affirmations).

CMS stopped posting stats when the Trump administration began, points out Sara Ratcliffe with the Illinois HomeCare & Hospice Council. “It seems they will not post anything until the new political appointees are in place,” Ratcliffe expects.

CMS’s PCR stats seem about right, Ratcliffe tells Eli. “We have done an independent survey of our members and CMS’s affirmation rate numbers seem to be accurate. I’m proud of how Illinois providers have tackled this challenge.”

But despite Illinois HHAs’ increasing success under PCR, the program is still extremely problematic, Ratcliffe stresses. “PCR continues to be a huge administrative burden,” she says. “Also, there is no solid indication that it is identifying any fraud.”

And the program is still likely to close some agency doors. While some agencies are succeeding, others are still struggling. “Agencies are having varying success with PCR submissions,” Ratcliffe reports.

Next fear: “Our immediate concern is that when Florida comes on board April 1, will the MAC, Palmetto, be able to handle the influx and how will that affect the PCR turnaround for Illinois?” Ratcliffe says.

Resource: If you missed Palmetto’s webcast on PCR documentation requirements last month (see Eli’s HCW, Vol. XXVI, No. 7), you have another chance to catch it March 22. The session will focus on documentation and clinical requirements reviewed in the project, the MAC says. Register for the webcast and access past sessions by going to www.palmettogba. com, clicking on “Jurisdiction M Home Health and Hospice” in the “Medicare Resources” box on the right, then clicking on “Home Health Pre-Claim Re-view” in the “Top Links” box, then clicking on “Self-Paced Learning” and scrolling down for links.