Days after deciding to pause its pre-claim review demonstration in Illinois and not expand the demo to Florida on April 1, CMS released 12 Q&As about the demo’s status.
 
One answer of particular note to Illinois agencies from the April 4 Q&As: What to do for claims if the agency already had submitted a pre-claim review (PCR) request and that request had been non-affirmed by the Medicare Administrative Contractor (MAC).
 
“Effective April 1, 2017, MACs will cease reviewing PCR requests, including resubmissions of PCR requests,” CMS wrote. “MACs will process home health claims under normal claim processing rules, without regard to whether a PCR decision was made and/or a Unique Tracking Number (UTN) is included on the claim.”
 
CMS announced March 31 that the demo would be paused for at least 30 days in Illinois. In the Q&As, CMS said during the pause it will consider making changes to improve the demo.
 
“CMS is considering a number of structural improvements in response to feedback received on the demonstration to date,” the federal Medicare agency wrote.
 
It’s not clear exactly when CMS will stop the pause — the federal Medicare agency said it will notify providers at least 30 days in advance of further developments about the demo.
 
“CMS does not have a timetable for further developments related to the demonstration and is exploring options to improve the program,” the federal Medicare agency wrote. “CMS will provide at least 30 days’ notice on its website prior to expanding the demonstration to (Florida) or any other state.
 
Related link: Read the Q&As at http://go.cms.gov/2oBWZuG.