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.