July 2016
The CMS Pre-Claim Review Demonstration:  Preparing Home Health Agencies for the Who, What, When, Where, Why & How

Simione Healthcare Consultants is pleased to provide this summary of the key provisions of the CMS Pre-Claim Review Demonstration, which was announced in the Federal Register on June 10, 2016. Home health providers in the five demonstration states (IL, FL, TX, MI, MA) must quickly implement new processes to meet the requirements of this new mandate, even though much of the implementation processes are still being developed between CMS and the Medicare Administrative Contractors (MACs).

Who is included in this demonstration?

CMS announced a Medicare pre-claim review demonstration for home health agencies (HHAs) that provide home health services and are enrolled in the Medicare program. The program requires HHAs within each of the participating states to submit a pre-claim review request and the necessary documentation to their respective Medicare Administrative Contractor (MAC) for Medicare fee for service patients.

Where & When does the demonstration occur?
  • Illinois: no earlier than August 1, 2016 - MAC is Palmetto
  • Florida: no earlier than October 1, 2016 - MAC is Palmetto (included in Home Health Value Based Purchasing pilot)
  • Texas: no earlier than December 1, 2016 - MAC is Palmetto
  • Michigan: no earlier than January 1, 2017 - MAC is NGS
  • Massachusetts: no earlier than January 1, 2017 - MAC is NGS (included in Home Health Value Based Purchasing pilot)
  • The demonstration will last for three years after implementation in each state.
  • During the first three months after that start date within each state, the final claims that are deemed payable without having a pre-claim review request will not be subject to a payment reduction (described below).


Complimentary Webinars 

July 21, 2016 @ 1-2 PM Eastern
Control Your Finances with Real-Time Benchmarking
Presenter:  Brian Martin, Vice President, Simione Financial Monitor 

July 27, 2016 @ 3-4:30 PM Eastern
Value-Based Purchasing: Developing Strategies That Pay for Patients & Providers
Presenters: Liz Silva, Director of Home Health & Hospice, HEALTHCAREfirst, and Kim Skehan, MSN, RN, Senior Manager, and Mike Simione, MBA, Manager, Simione Healthcare Consultants

July 10-12National Association for Home Care & Hospice Financial Management Conference, Red Rock Casino Resort & Spa, Las Vegas, NV
July 31-Aug 4
Home Care Association of Florida Annual Conference, Renaissance Orlando @ SeaWorld, Orlando, FL
Aug 29-31Carolinas Center for Hospice & End of Life Care Annual Conference, Omni Hotel, Charlotte, NC
Sept 8Home Care Association of New York State, Senior & Financial Managers Retreat, Mohonk Mountain House, New Paltz, NY
Sept 13-14Ohio Council for Home Care & Hospice Annual Conference, Hyatt Regency, Columbus, OH
Sept 15-17
Nurse Next Door Annual Conference, Vancouver Marriott Pinnacle Downtown Hotel, Vancouver, BC
Sept 19-21
Association for Home & Hospice Care of North Carolina Convention & Expo, Holiday Inn Resort, Wrightsville Beach, NC
Sept 20-21The 3rd Annual Simione Strategic Growth & Sales Leadership Summit, The Cosmopolitan of Las Vegas, Las Vegas, NV (Register at simionetraining.com)
Sept 27McKesson Users Conference, Grand Hyatt, San Antonio, TX
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