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MAC tries to educate Florida docs about PCR.

Although the Pre-Claim Review program is on hiatus in the four remaining demonstration states, MAC preparations indicate the program could resume at any time.

For example: HHH Medicare Administrative Contractor Palmetto GBA held webcasts on Sept. 20 and Sept. 27 about PCR implementation in Florida. The earlier webcast aimed to educate referring and certifying physicians about their role in PCR, while the later one reviewed operational details for home health agencies that will participate in the program.

Resource: Links to the webcast recordings and handouts (as well as many other tools) are on Palmetto’s PCR site at www.palmettogba.com (click on “Jurisdiction M Home Health and Hospice,” then click on “Home Health Pre-Claim Review” in the “Top Links” box).

And MAC CGS has added a number of tools to its PCR website at as well, including job aids on Beneficiary Provisionally Affirm/Non-Affirm Letters, Provider Provisionally Affirm/Non-Affirm Letters, and a Home Health Pre-Claim Review Online.

Palmetto has posted its beneficiary education letter and fact sheet as well.

HHAs are hoping that these resources are rendered unnecessary by new legislation introduced in the House. H.R. 6226 would impose a one-year moratorium on PCR in all demonstration states — including Illinois. The Pre-Claim Undermines Seniors’

Health (PUSH) Act introduced by Reps. Tom Price (R-Ga.) and James McGovern (D-Mass.) would also require the Centers for Medicare & Medicaid Services to report to Congress on PCR’s impact on patients, home health agencies, physicians, and Medicare spending.

The legislation comes as PCR’s burden continues to crush Illinois HHAs. Illinois providers have experienced “a 60-80 percent non-affirmed rate, burdensome and time-consuming paperwork, an inefficient electronic system that cannot process the documentation, physician unfamiliarity with what is needed for PCR due to poor education from CMS and their contractor, and considerable cash flow problems at agencies,” according to the National Association for Home Care & Hospice.

Agencies can’t rely on CMS’s self-imposed delay, stresses the Visiting Nurse Associations of America. “The project continues to operate in Illinois and could be reinitiated by CMS in other states in future months,” the trade group warns in a release.

“More red tape that potentially jeopardizes patient care is not the answer,” VNAA continues. “That’s why we need to delay Pre-Claim Review until better alternatives can be agreed upon.”