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What Docs Need to Know About Illinois' New Home Health Review Process
Posted on: 1/5/2017

The Centers for Medicare and Medicaid Services (CMS) rolled out the home health Pre-Claim Review Demonstration (PCRD) project last August in Illinois, much to the dismay of many physicians. Illinois remains the only state in the demonstration after CMS acted to delay rollout in other states due to implementation concerns. Despite ISMS’ opposition, the PCRD is still in operation here … for now.

In a nutshell, home health agencies must now submit complete documentation earlier in the process to the Medicare administrative carrier for services provided to Medicare patients. So no more submitting documentation at the same time as the claim – hence the name "pre-claim review."

While the focus of PCRD is on reimbursement to the agencies, ISMS argues that this process places new burdens on physicians who certify patients for home health services and could jeopardize access to care for Illinois' vulnerable senior citizens.

The Illinois Homecare and Hospice Council has developed a flyer with background on the PCRD process.  


Does your practice or group need help demystifying PCRD or any other topic? ISMS members and their practice management professionals can contact us for hands-on support. Call your ISMS Advocacy Team at 800-782-4767 ext. 1470 or send an email.



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