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What the Possible Return of Pre-Claim Review Demonstration Means for Home Health Care Agencies

The Return of the Pre-Claim Review Demonstration: What is Different?

CMS recently announced that they are planning to introduce a revised version of the PCR program. Once again, Illinois will be the first state targeted. The updated program is designed to give providers more choice and flexibility with submitting their claims and reward providers who demonstrate compliance with CMS home health policies. Under the new plan, providers have three choices of how to go about their claim review. HHAs may choose to undergo either pre-claim review or post-payment review. Providers may also choose to skip out on either options and instead simply face “minimal post-payment review.” However, the latter option will result in a 25% payment reduction. Like in the original version of the initiative, PCR does not require any additional documentation than what is standard for claim review.

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A Brief Overview of QAPI initiatives for Home Health Care Agencies

The Home Health Agency QAPI Program

The new CMS Conditions of Participation (CoPs) for home health agencies are switching things up for home health care providers. As of January 13, 2018, home health agencies have a new set of guidelines they must adhere to in order to be part of the CMS program and be eligible for reimbursement. One of the new CoPs is the establishment of a Quality Assessment and Performance Improvement (QAPI) initiative for home health agencies.

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A Brief Overview of the New Home Health Agency Conditions of Participation

As any healthcare provider involved with the Centers for Medicare and Medicaid Services knows, following CMS directives is critical. That makes it all the more stressful when new rules are introduced or guidelines change. Such is the case with the new Home Health Agency Conditions of Participation (CoPs) that rolled out this year.

As of January 13, 2018, home health agencies have a new set of rules to follow. Initially slated for a 2017 implementation, CMS delayed the enactment as they tweaked the new CoPs to get them to their final stage, which is now applicable to all home health care agencies. CMS mandates can be confusing enough to begin with, but the new CoPs make this year especially challenging for home health agencies.

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