Home Health Pre-Claim Review Demonstration Suspended Until Further Notice

On Friday, March 31st, CMS announced that as of April 1, 2017, the Home Health Pre-Claim Review Demonstration (PCR) would be suspended for at least 30 days in Illinois. Additionally, the Demonstration would not expand to Florida on April 1, 2017 as orginally planned. It indicated that the suspension of the Demonstration was enacted to consider a number of changes for structural improvement of the program.

Beginning April 1, 2017, and continuing throughout the pause, the Medicare Administrative Contractors will not accept or process any Home Health Pre-Claim Review requests, regardless of date of service listed on the PCR request. During the pause, home health claims should continue to be submitted for payment and will be paid under normal claim processing rules. Resubmissions of rejected submissions will not be accepted. PCRs that were already submitted and received an affirmation can include the UTN on claims and will continue to be excluded from Recovery Audit Contractor (RAC) and Supplemental Medical Review Contractor postpayment reviews and most MAC prepayment and postpayment reviews.

It is unknown how this delay will affect the implementation dates in Texas, Michigan, and Massachusetts, but CMS said they will notify providers at least 30 days in advance via an update to its website prior to resuming or beginning the Home Health Pre-Claim Review Demonstration in any state.

View the “Home Health Pre-Claim Review (PCR) Demonstration Pause Questions and Answers” document released by CMS to answer questions regarding the status of the Home Health Pre-Claim Review Demonstration. Further clarification by CMS can be found here.

HEALTHCAREfirst will continue to monitor the PCR Demonstration and will provide updates as they happen.