Home Health & Hospice Week

Good news: You can now save a Pre-Claim Review request in progress.

Whether request denials in the Pre-Claim Review demonstration are running at 60 percent or 80 percent, they are still bogging down home health agencies’ operations and poised to wreak reimbursement havoc when RAPs start timing out. In the first weeks of the PCR demo in Illinois, participating agencies have reported “nonaffirmation” figures of 70 to 80 percent, say the National Association for Home Care & Hospice and sources in the state.

But Medicare Administrative Contractor Palmetto GBA says its denial data doesn’t match that figure. “From the limited number of Pre-Claim Review requests received by Palmetto GBA thus far, we are seeing non-affirmation rates in line with [Comprehensive Error Rate Testing] data,” a MAC rep tells Eli. “The 2015 national CERT Error rate for Home Health is 59.0 percent.”

And the MAC expects that figure to improve. “Palmetto GBA anticipates non-affirmation rates will decrease in the coming months as providers apply the education offered in the decision letters for each non-affirmation,” the Palmetto source says.

Good news: After agencies have complained of numerous technical problems, “enhancements were made to the eServices provider portal to facilitate the providers’ ability to successfully submit,” the rep adds. Most notably, HHAs now have the ability to save a work in progress in order to prevent application timeouts.

Stay tuned: “The portal has additional enhancements on the horizon to make it even easier for providers to submit their PCR requests,” the Palmetto rep says. Keep an eye on Palmetto GBA’s listserv messages to providers for updates as they occur.

Resource: For PCR-related educational information and resources go to www.palmettogba.com/HHH — in the box titled “Top Links” select Home Health Pre-claim Review. “From this web page, providers can access all educational resources available to assist them,” the rep advises.

Meanwhile, the industry continues to work to get the demo suspended or at least modified. In a Sept. 7 House Ways and Means Health Subcommittee hearing on quality in Medicare Part A, Rep. Tom Price (R-Ga.) questioned Almost Family President Steve Guenthner about PCR, reports the National Association for Home Care & Hospice.

Price raised the idea of a PCR delay and reform of face-to-face requirements. He also questioned the Home Health Value-Based Purchasing withhold level that will reach 8 percent, when other provider types’ VBP withhold levels are capped much lower at 1 or 2 percent, NAHC reports in its member newsletter.