CMS recently announced a possible revisit to prior authorization demonstration for home care agencies.
- Expect approximately 40% decrease in agency numbers by end of CMS demonstration.
- Some experts believe agencies will require 1.5 additional FTEs (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.
- Billing for the initial RAP with a review of documentation present at the time of RAP.
Let QIRT be your 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.