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Even agencies that qualify for exemption will be subject to 5% \u2018spot check.\u2019<\/em><\/strong><\/span><\/p>\n One of the most pressing questions for the home health agencies scheduled to undergo the relaunched Pre-Claim Review demonstration first is how hard it will be to get quick relief from the program.<\/p>\n Unlike in the old PCR demo, the renamed Review Choice Demonstration sets out a way for HHAs to get off the heavy review track. Providers that choose the 100 percent pre-claim review or the 100 percent post-pay review (as opposed to taking the 25 percent penalty) \u201cwill continue to be subject to a review method until the HHA reaches the target affirmation or claim approval rate,\u201d CMS explains in a supporting Paperwork Reduction Act filing.<\/p>\n That \u201capproval rate\u201d will be 90 percent, \u201cbased on a minimum of 10 pre-claim requests or claims submitted,\u201d CMS spells out.<\/p>\n What happens next:<\/span>\u00a0<\/strong>\u201cOnce a HHA reaches the target pre-claim review affirmation or post-payment review claim approval rate, it may choose to be relieved from claim reviews, except for a spot check of 5 percent of their claims to ensure continued compliance,\u201d CMS continues.<\/p>\n Alternative:<\/span>\u00a0<\/strong>\u201cThe HHA may also instead choose to continue or start participating in pre-claim review, or choose to participate in selective post-payment review based on a statistically valid random sample,\u201d CMS adds in the PRA document.<\/p>\n While getting a specific number for exemption is good, CMS still has many questions left to answer about the exemption option. Agencies need \u201cthe specifics,\u201d\u00a0William Dombi<\/strong>, president of the\u00a0National Association for Home Care & Hospice <\/strong>says.<\/p>\n For example:<\/span>\u00a0<\/strong>\u201cWhat does that mean for a large agency \u2014 only 10 or much more?\u201d asks\u00a0Sara Ratcliffe<\/strong>, executive director of the\u00a0Illinois HomeCare & Hospice Council<\/strong>, of the \u201cminimum of 10\u201d language.<\/p>\n Plus:\u00a0<\/strong><\/span>\u201cWe would like to know if Illinois agencies that had already achieved 90 percent affirmation or higher the first time around with PCR could be exempt this time,\u201d Ratcliffe adds.<\/p>\n <\/p>\n Source- SuperCoder<\/span><\/i><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"