Call 855.485.QIRT for more information

Call 855.485.QIRT for more information

Pre-Claim Reviews

CMS recently announced they will go ahead with the prior authorization demonstration for home care agencies in Illinois, Florida, Texas, Michigan, and Massachusetts. 

REQUIREMENT IS BASED ON WHERE SERVICES ARE RENDERED, NOT BY LOCATION OF PROVIDER.

  1. Expect approximately 40% decrease in agency numbers by end of CMS demonstration.  

  2. Some experts believe agencies will require 1.5 additional FTE’s (1 RN and 1 clerical) for every 100 patient census. 

  3. Do not resubmit claims until all information is collected.  

  4. Be sure to attach the assigned pre-claim number to all final claims and resubmissions.  

  5. Consider outsourcing this service.  

The Solution

QIRT has formed a highly trained and credentialed Pre-Claim Review (PCR) Team. This team is specifically trained to review the documentation in the patient medical record related to the 5 Tasks. 

The team will utilize tools that will alert the agency that:  

All documentation is in one place and the agency can submit to the intermediary OR  

One or more pieces of documentation is still needed before submission. 

The team will work with the agency to put the required documentation in one place. 

QIRT can provide:

  • Coding/OASIS Review to ensure coding and assessment documentation relate to the F2F encounter and need for home care. 
  • PCRs independently
  • Coding/OASIS Review and then PCR Review and then billing for the initial RAP with a review of documentation present at the time of RAP 

Let QIRT be your outsourced solution.

Free your staff to focus on what is necessary and important: 

  • Provision of care 
  • Documentation of care necessary for:  

 An auditor to form a picture about this specific patient 

 Care needed by the patient, provided by the agency, and documented by the clinician.

Contact Us

QIRT is dedicated to helping home health and hospice organizations achieve Quality Assurance goals by offering personalized services in four distinct, complimentary divisions: Quality, Clinical, Financial, and Education.

15 Verbena Avenue, Suite 210, Floral Park, NY 11001

855.485.QIRT (7478)

855.485.QIRT (7478)

516.706.3341

516.706.3341

Recent News

  • QIRT Welcomes Corinne Kuypers-Denlinger as VP of Post-Acute Growth Strategies Learn More

    Wednesday, March 8, 2017


  • QIRT CEO, Laura Page-Greifinger, Named as a Long Island Future 50 Award Winner Learn More

    Monday, January 9, 2017


  • For the 4th Time, QIRT (Quality In Real Time) Appears on the Inc. 5000 list, Ranking No. 1452 Learn More

    Wednesday, August 17, 2016


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