CMS Data on Illinois Pre-Claim Review is Misleading
The Centers for Medicare and Medicaid Services released “Early Data from Illinois,” regarding the pre-claim review (PCR) demonstration program begun in that state on August 3, 2016.
The CMS attempts to project a relatively benign image of the PCR demonstration, the truth is that the data presented and the data that is missing both indicate that the problems PCR has created for home health agencies (HHA) and their patients are significant and, if anything, growing worse.
CMS indicates that 91 percent of review requests were submitted through the contractor’s online portal, with the time to complete the submission dropping from a 12-minute average to nine minutes by week eight. However, this data is highly misleading and does not include the extensive time needed to collect the documentation for submission or the time it takes to review all the documentation for compliance. Assembling, reviewing and submitting this documentation is a new requirement under the PCR experiment and an HHA study shows that the new functions take nearly one hour of nurse time per pre-claim review submission, not merely the 9-12 minutes spent online at the contractor’s portal.
:: Read Full Article