Pre-Claim Review Demonstration Update

CMS Delays Pre-Claim Review Demonstration in Florida

On September 19, 2016, CMS announced that it would delay the start date of the Pre-Claim Review Demonstration for Florida. According to the CMS notice, ” Based on early information from Illinois, CMS believes additional education efforts will be helpful before expansion of the demonstration to other states; therefore, we will not move forward with initiating the demonstration in Florida in October. This education effort will focus on how to submit pre-claim review requests, documentation requirements, and common reasons for non-affirmation.” While a new start date for Florida has not been announced, CMS said it would provide at least 30 days’ notice prior to beginning the demonstration in any state.

This delay does not affect the Pre-Claim Review Demonstration in Illinois and these home health care providers are required to continue pre-claim review submissions.

Pre-Claim Review is a process by which a request for coverage is submitted for review before a final claim is submitted for payment. The Pre-Claim Review Demonstration began on August 3, 2016 in Illinois with Florida, Texas, Michigan, and Massachusetts scheduled to follow. As previously planned, CMS does expect a staggered start, beginning with Florida.

Click here to download A Guide to the Pre-Claim Review Process. For additional questions , please contact us at info@healthcarefirst.com or 800.841.6095.

September 21, 2016

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