Agencies Question MAC Readiness for Pre-Claim Submissions

With less than two weeks until the first Pre-Claim Review Demonstration by the Centers for Medicare & Medicaid Services (CMS) begins in Illinois, home health care providers are eager to get their last-minute question answered. In the most recent public call with CMS, home health providers were mostly concerned with technical issues related to submissions.

The demonstration is set to roll out August 1 in Illinois, followed by Florida after October 1; Texas after December 1; Michigan after January 1, 2017; and Massachusetts after January 1, 2017.

CMS officials and representatives from various Medicare Administrative Contractors (MACs) once again affirmed that the pre-claim process would not result in delayed payments or services to home health patients under the Medicare benefit.


“MACs will make every effort to review initial requests within 10 days,” CMS officials said.

Responding to questions from providers on how MACs will be able to answer all pre-claims in a timely fashion and who exactly would be reviewing the documentation, representatives said additional hiring and training was already underway.

“We do have a process in place and are prepared to handle them starting today,” officials said Wednesday.


However, providers still had some questions when it came to technical aspects of the requirements. With a shortened timeline goal of 10 days to review and return or accept pre-claim submissions, home health providers wanted to know how MACs would be accepting pre-claim documentation. Some MACs accept only electronic documentation, while others may only accept fax or mailed-in claims.

MAC representatives noted they were sharing best practices with one another and working on the best techniques before the program gets underway. At this point, there appears to be little standardization between the MACs in terms of review demonstration processes.

Home health agencies also remained concerned about the timeliness of securing a physician’s signature on a plan of care prior to submitting a pre-claim document.

Written by Amy Baxter

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