Home Health & Hospice Week

Multiple avenues for submission available.

Question: How should we submit pre-claim review requests under the new demonstration?

Answer: “Submitters … may send pre-claim review requests to the Medicare Administrative Contractors (MACs) via mail, fax, or through the Electronic Submission of Medical Documentation (esMD) system,” the Centers for Medicare & Medicaid Services says in a new question-and-answer document about the demo. MACs also may make the process available through their own portal sites, a CMS official added in the June 14 special Open Door Forum on the demo. “The method used to submit the request is the same method that will be used to send the decision. More information on esMD and availability can be found at http://www.cms.gov/esMD.”

More details about the pre-claim review request submission process and subsequent billing of affirmed claims will be available in CMS’s imminent operational manual about the demo, as well as on MACs’ websites, CMS said in the forum.

Note: The set of 31 demo Q&As is at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Downloads/FAQ.pdf.