Home Health & Hospice Week

Prepare to match pre-claim requests’ Unique Tracking Numbers with final claims.

Question: What information will we have to submit on our pre-claim review requests under the new demonstration?

Answer: The answer to this question is urgent for home health agencies in the five states that will start the pre-claim review demonstration in the coming months. That’s particularly true for agencies in Illinois, since the Centers for Medicare & Medicaid Services said in a recent special Open Door Forum on the demo that it plans to stick to its Aug. 1 start date for that state (see Eli’s HCW, Vol. XXV, No. 23).

Procedural details about the demo will be in the operational manual that CMS says it will issue very soon. But in the meantime, a CMS official did detail in the June 14 forum what information will be required on the pre-claim review request:

• Beneficiary name
• Beneficiary’s Medicare number
• Beneficiary’s Date of Birth
• Beneficiary’s gender
• Certifying physician name
• Certifying physician National Provider Identification (NPI) number
• Certifying physician address
• Benefit period requested
• Submission date
• From and through date of episode
• Whether the request is an initial request or a resubmission
• The state where service is rendered
• Requestor contact information

The HHA name, NPI and address will also be required, notes the National Association for Home Care & Hospice in its member newsletter. And Provider Transaction Access Numbers (PTANs) will be optional for the certifying physician and HHA, NAHC adds.

CMS expects HHAs to be the ones submitting the requests in most cases. But whether the request comes from an agency or a beneficiary, the bene will be notified of the decision, a CMS staffer said in the forum.

When an HHA submits a request, it will receive a decision letter from its HHH Medicare Administrative Contractor that contains a Unique Tracking Number (UTN), the CMS official explained. Agencies then must include the UTN on the related final claim they submit.

Watch for: HHAs will place the UTN in field locator 63 of a paper claim 1450 (UB-04), a CMS staffer said in the forum. On electronic claims, it will go in Positions 19-32 at Loop 2300. When a caller pointed out that the OASIS-claim matching key already goes there, the rep said to stay tuned for a clarification.

The UTN is required to show that an agency undertook a pre-claim review for a final claim, to avoid the 25 percent penalty that not going through the process will carry after the first three months of the demo.

Note: More info about the demo is at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Overview.html. CMS’s second special Open Door Forum on the demo is June 28 from 2-3 p.m. To participate, dial 1-800-837-1935 and use Conference ID No. 94883951. More information about the forum is at www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/ODFSpecialODF.html.