CMS Pre Claim Review - Curse or Cure?

Event Information
Product Format
Prerecorded Event
60 minutes
Product Description

Get Expert Tips and Advice on Clearing the CMS’ Pre-Claim Review Process

Demonstrations by CMS are not new to homecare. What is New is an entire review of your claims before submission of those claims. While CMS claims this is a way to ‘prevent fraud’, the results of this egregious rule is causing absolute chaos in those States affected. This is reported to be a 3 year demonstration in 5 States, but it is already causing a path of undue hardship in Illinois.

However, CMS is not budging. To date, there are few claims getting through the Pre-Claim Review process with “non-affirmations”. CMS is quick to point out that these non-affirmations are not ‘denials’, but simply letting you know the claim will not be paid. The entire industry needs to understand this process. This could very well become the payment future for home health care in all states. There has never been a more incredible reimbursement change since the imposition of IPS in the late 1990’s. This rule has the potential of closing more than 50% of agencies in the demonstration States.

Join this session by expert speaker Arlene Maxim to get tips for clearing the PCR process. The session will also provide you a copy of one MAC’s work flow with advice on submission. Given the impact and importance of this new rule, no homecare owner or manager should miss the opportunity to learn about it. This webinar will provide the most up-to-date information from Agencies in Illinois on just how they are handling the CMS Pre-Claim Review rule.

Session Highlights:

  • Understand exactly WHAT information the MAC expects to be submitted for pre-claim reviews.
  • How internal practices need to change in facing the challenge of Pre-Claim Review?
  • Improving Face to Face submissions for the best chance of affirmation.
  • Why G-codes applied to your claims will cause multiple problems during the first level of review for PCR?
  • What are your chances of additional reviews and denials on claims that are ‘affirmed’?

 Arlene will also discuss:

  • Difference in Prior Authorization and Pre-Claim Review (PCR)
  • PCR Documentation Requirements
  • Dealing with Reduced Cash Flows
  • Educating Agency Staff, Patients, Physicians
  • Required Documentation by MAC Task
  • Change Request 9119
  • Face to Face Documentation
  • Recertification CR 9119
  • Tips on Compliance with the Rule
  • Creating a Continuous Documentation Program
  • HCPCS codes, G codes
  • Assessing Staffing Levels

Who Should Attend

  • Owners
  • Managers
  • Supervisory staff

Order Below or Call 1-844-384-4744 Today

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About Our Speaker

Arlene Maxim - Home Health and Hospice Expert

Arlene Maxim currently holds the position of Vice President of Program Development for Quality in Real Time (QIRT) based in Floral Park, New York. She has been in home care since 1979 and has been a home health care consultant since 1986. Drawing on her strong clinical background, she has served in various capacities from home care administrator to home care agency owner and home care consultant. She...   More Info
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