Home Health & Hospice Week

Adjusted claims won’t require a complete do-over.

With the onset of pre-claim review mere days away, the HHH Medicare Administrative Contractor handling the vast majority of initial PCR claims says it is ready to roll.

MAC Palmetto GBA is fully staffed up for the new program, said a Palmetto representative in the Centers for Medicare & Medicaid Services special Open Door Forum on PCR July 20. Illinois’ Aug. 1 start date is coming quick, but “we feel ready,” she claimed.

So far, Palmetto is the only MAC that is. MAC CGS has a PCR website and just issued a cover sheet home health agencies can use with their PCR request submissions, a CGS rep said in the call. The MAC is accepting requests only via mail or fax for now, but is working on a portal for electronic PCR submission.

MAC National Government Services is still working on its rollout, a CMS staffer told forum attendees. NGS didn’t have a rep speaking in the call.

CMS and Palmetto offered a number of PCR clarifications in the forum, including:

• Contrary to what Palmetto said in earlier educational sessions, agencies should be able to continue with an originally affirmed Unique Tracking Number when they add services to a claim, the

Palmetto official said. The provider won’t have to resubmit the request all over again to get a new affirmation and UTN. HHAs should be sure their documentation supports the change, and agencies that are outliers in these types of claims should expect scrutiny, the CMS source added.

• Stay tuned for how to deal with Palmetto’s auto-cancel protocol, which starts paying HHAs zero dollars for Requests for Anticipated Payment if they exceed a certain RAP auto-cancel threshold. Palmetto doesn’t want to penalize agencies that are working through the PCR process and have RAPs auto-cancel, so it’s looking into the issue, the MAC staffer said.
•  You only have to worry about the face-to-face rule that applied at the time of the initial episode for long-stay patients. Reviewers won’t judge patients based on today’s standards when previous — or no — F2F rules were in place at the time of admission, the Palmetto rep clarified.
• Links to transcripts for CMS’s June forums on PCR are in the “Downloads” box at www.cms.gov/outreach-and-education/outreach/opendoorforums/ODFspecialODF.html.

Note: CMS’s PCR page is at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Overview.html.