Pre-Claim Review Demonstration for Home Health Services Officially Began in Illinois on August 3, 2016

As the Pre-Claim Review Demonstration for Home Health Services goes into effect in Illinois, we are instructing Home Health Agencies (HHAs) in Illinois not to submit pre-claim review requests for episodes of care that began prior to August 3, 2016. 

In order to allow time to resolve an administrative procedural requirement related to the Paperwork Reduction Act, implementation of the Pre-Claim Review Demonstration for Home Health Services in Illinois began on August 3, 2016.  The revised start date does not impact demonstration requirements or processes, and the demonstration will be operationalized as planned for episodes of care starting on or after August 3, 2016. CMS’ Medicare Administrative Contractors will work directly with any HHAs that submitted requests for episodes of care that began prior to August 3, 2016 and allow them to either have the requests withdrawn or processed as test requests. 

More information may be found on our website at:  https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Pre-Claim-Review-Initiatives/Overview.html.  Please see the Frequently Asked Questions in the “Downloads” section.  Also refer to your Medicare Administrative Contractor’s website for specific instructions.