Medicare pre-claim review requirements have started, and could lead to reimbursement delays
The CMS has begun a trial of a new pre-claim review process in Illinois on August 1st. This new program requires home health care providers to submit claims to CMS contractors much earlier in the care process, to be audited before the claim is actually submitted for payment. The CMS has pitched this to home health agencies as a simple change to the revenue cycle, putting the pre-claim review authorization in as an added step before claim submission. However we are hearing that this is not the case.
Since the August 1st start of the trial, Illinois healthcare agencies are experiencing:
- Delays in claim submission and approval
- Increase in workload for having to read applicable documentation
- A process that has been updated 3 times since it began
- Delays in being able to provide care to patients
Click here to watch a video interview with a Illinois home health agency discussing their experience with the program
These problems are ultimately leading to increased workload to submit claims and delays in reimbursement. As a healthcare provider, the last thing you need to deal with is an even more complicated reimbursement process. The CMS has announced this will roll out next in Florida, with Texas, Michigan and Massachusetts to follow. The rest of the country won’t be too far behind.
Home healthcare agencies are working to put in place finance facilities to weather the expected disruption to their cash flow. Contact us to find out how we can help you have funds on hand to make sure you do not run into trouble meeting your daily expenses.