Update: On March 31, 2017, CMS stated that the Pre-Claim Review Demonstration will not expand to Florida on April 1, 2017 as planned. CMS will notify providers at least 30 days in advance via an update on their website of further developments related to the demonstration. HEALTHCAREfirst will continue to monitor the status, provide updates as information is made available and distribute resources such as the pre-claim review guide.

CMS has scheduled the expansion of the Pre-Claim Review Demonstration to Florida for home health services that begin on or after April 1, 2017. While there is a lot of buzz about potential delays, home health agencies should not put their preparation on the backburner.

The purpose behind this demonstration is to determine if a pre-claim review process would ensure medical necessity of home health services, without delaying or disrupting patient care or access. It will also help determine if it would reduce expenditures while maintaining or improving care quality. If HHAs in the demonstration states do not submit claims to the pre-claim review process, those claims will be stopped for pre-payment review.

Don’t delay! Your agency should be ready to submit pre-claim review requests, provide necessary documentation, and be familiar with common reasons for non-affirmation decisions.

Be prepared! Download your free  Pre-Claim Review Guide  to learn more about the pre-claim review process, read frequently asked questions, and discover six key tips for preparation.

Contact HEALTHCAREfirst to learn how we can help your agency with pre-claim review!