CMS’ pre-claim review demonstration, which has caused great consternation for Illinois agencies this year, is expanding to Florida in April 2017, the Federal Medicare agency announced Dec. 19.
 
Pre-claim reviews will occur for services beginning on or after April 1.
 
“CMS and the Medicare Administrative Contractors have provided education to impacted providers on how to submit pre-claim review requests, documentation requirements and common reasons for non-affirmation decisions,” CMS posted on its website. “The Medicare Administrative Contractors will continue to conduct outreach in Florida.”
 
Illinois’ reviews began Aug. 3 and the other states were expected to follow in the coming months. But early results of Illinois’ reviews led CMS to postpone the Oct. 1, 2016, start date for pre-claim reviews for Florida agencies (HHL 9/20/16).
 
New data show Illinois agencies’ results have improved in the months after the demonstration began.
 
On Dec. 9, CMS released data showing that nearly 83% of pre-claim review requests during the demonstration’s 18th week received a fully affirmed decision. By comparison, only about 30% of claims during the demonstration’s third week received a fully affirmed decision.
 
CMS’ three-year demonstration involves is also expected to involve claims in Texas, Michigan and Massachusetts. CMS has not yet announced the start dates for the demonstration in those states. 
 
While CMS plans to expand the demonstration, some industry experts believe there’s a possibility that with Republicans in control of Congress and the White House, the demonstration might end in 2017. Republican leadership in Washington has expressed serious concerns about it.
 
Related links: View a fact sheet about the expansion at http://go.cms.gov/2hW2b5Y. Read the latest pre-claim review data at http://go.cms.gov/2i5SPYD.