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.
- Expect approximately 40% decrease in agency numbers by end of CMS demonstration.
- Some experts believe agencies will require 1.5 additional FTE’s (1 RN and 1 clerical) for every 100 patient census.
- Do not resubmit claims until all information is collected.
- Be sure to attach the assigned pre-claim number to all final claims and resubmissions.
- Consider outsourcing this service.
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.