Agencies waiting with dread for pre-claim reviews to begin in their states can breathe a slight sigh of relief — CMS announced Sept. 19 that the demonstration is on hold outside of Illinois.
 
Early results of Illinois’ reviews led CMS to postpone the Oct. 1 start date for its pre-claim review for Florida’s home health agencies.
 
More educational effort is vital to the demonstration’s long-term success, CMS says. As a result, the federal Medicare agency will “take additional time prior to expanding to other states.”
 
Illinois’ review began Aug. 3. CMS has not released data about the demonstration, but Bobby Lolley, executive director of the Home Care Association of Florida, says Medicare Administrative Contractor (MAC) Palmetto GBA announced that unofficial early results of Illinois’ demonstration show a non-affirmation rate of about 60%.
 
Palmetto indicated many of those non-affirmations occurred because agencies didn’t submit certain documents that were requested, Lolley says.
 
CMS’ additional education will focus on how to submit pre-claim review requests, documentation requirements and common reasons claims are being non-affirmed.    
 
CMS did not announce new start dates for pre-claim reviews in Florida, Texas, Michigan and Massachusetts, but it said it will give agencies in affected states at least 30 days’ notice on its website.
 
“CMS continues to expect a staggered start, beginning with Florida,” the federal Medicare agency announced.
 
CMS’ announcement comes weeks after Florida’s U.S. senators expressed concern about the demonstration and called for a delay in the state’s start date (HHL 9/19/16).
 
Lolley, for one, believes the demonstration still will come to Florida eventually. Palmetto has assured providers that it already has hired and trained “hundreds” of nurses for the demonstration, he says.
 
But for now, Medicare is still “working out the bugs” about the demonstration, Lolley says.
 
As of Sept. 20, Florida’s physicians had not received letters educating them about the demonstration, he says.
 
Palmetto only recently has begun providing Illinois’ agencies with greater detail about why their claims have been non-affirmed, he says. And MAC CGS is still telling agencies their best method to submit documentation is via fax.