Home Health & Hospice Week

Otherwise claims will process as normal.

Home health agencies left with questions after the halt of Pre-Claim Review was announced have gotten at least some answers in a new questionand-answer set.

“After March 31, 2017, and continuing throughout the pause, the Medicare Administrative Contractors will not accept any Pre-Claim Review requests,” the Centers for Medicare & Medicaid Services said in its March 31 announcement temporarily halting PCR in Illinois and delaying the PCR start date in Florida (see story, p. 106). “During the pause, home health claims can be submitted for payment and will be paid under normal claim processing rules.”

But there is one exception to the “normal” processing procedure regarding Unique Tracking Numbers, CMS says in the Q&A set posted April 4. “Providers that received UTNs (indicating that a PCR decision was rendered)” before the pause announcement “are encouraged to include such UTNs on home health claims they submit, even those claims submitted after April 1, 2017,” CMS says. “Claims submitted with a UTN will continue to be excluded from Recovery Audit Contractor (RAC) and Supplemental Medical Review Contractor postpayment reviews and most MAC prepayment and postpayment reviews.”

Other highlights from the Q&As include:

• The April 1 date for pausing PCR applies to submission dates, not to dates of service on the claims. That means you now can submit pre-April 1 claims with no requests or tracking numbers and not undergo pre-pay review or payment reductions.
• Claims submitted April 1 and later, however, will not get paid automatically, CMS points out. They will undergo “normal” claims processing, which may include review.
• If you got a non-affirmation decision for a request before April 1, you can now just submit that claim normally. You don’t need to resubmit the PCR request.

Note: See the 12 Q&As at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Downloads/Pre-Claim_Review_Pause_QandAs_04-04-2017.pdf.