The Centers for Medicare and Medicaid Services (CMS) announced it would shelve Illinois' home health
pre-claim review demonstration (PCRD) project, which rolled out last August.
As of April 1, 2017, home health claims are being handled under the normal claim processing rules, regardless of whether the claim underwent PCRD. In other words, claims will be processed just as they were before Aug. 3, 2016, when the demonstration project began.
While PCRD is suspended in Illinois, CMS will consider a number of changes and structural improvements based on the feedback received to date.
Illinois was the first of five states that CMS planned for the demonstration. But once launched in the Prairie State, it became obvious that PCRD was fraught with problems and implementation plans for the four other states were put on ice. Finally, the project came to a screeching halt here in Illinois.
Our physician members had expressed concerns right from the beginning that PCRD would create additional administrative burdens and could ultimately jeopardize access to home health services for Illinois’ elderly residents.
ISMS' advocacy opposing this project was significant. We voiced our firm opposition to CMS and the Illinois congressional delegation and helped doctors share their concerns directly with CMS and Congress.
A big thanks to all who contacted lawmakers to express your concerns as the voice of medicine. Illinois needs to preserve patient access to home health care services while maintaining quality care for seniors!
The pre-claim review demonstration (PCRD) project required home health agencies in Illinois to submit documentation for services provided to Medicare patients before they submitted the actual claim for services. Under the "pre-claim review," agencies were required to collect and submit all documentation much earlier in the process.
The project was launched to help close fraud and abuse loopholes associated with home health claims.