Pre-Claim Review Implementation

MCALLEN | October 11            SAN ANTONIO | October 13             HOUSTON | November 16             DALLAS | November 17


The Centers for Medicare & Medicaid Services (CMS) posted last night that they are delaying the roll out of Pre-Claim Review (PCR) to the other states (FL, TX, MI, and MA). Full report here. The delay is NOT a permanent repeal of PCR. PCR will return.

TAHC&H PCR education with Palmetto GBA speakers is still on for October & November!  As confirmed today with Palmetto GBA, this is just a temporary delay and we must be vigilant in ensuring agencies are prepared.   Palmetto GBA has much to share about the Illinois experience.  Many of the practices you may employ today are NOT working with PCR; specifically use of a F2F form with MD narrative, for example.     

Please note!   CMS is watching to see how many Texas agencies attend workshops and make an effort to prepare for PCR.   All in-person workshops performed by the Medicare Administrative Contractors (MACs) require providers to sign in using their Medicare Identifier. CMA collects aggregate data to evaluate industry educational uptake.  Please don't make the mistake of thinking PCR education is not necessary due to this temporary delay.      

YOU MUST BE READY!  Register today and do not miss out on this opportunity to improve your practice in preparation for this project.

Palmetto GBA and CGS Tours Texas in Partnership with TAHC&H

In partnership with the Texas Association for Home Care and Hospice, Palmetto GBA is partnering with CGS and is coming to 4 sites across Texas to provide education on Pre-Claim review.

These identical workshops are designed to clarify the pre-claim review process for Medicare participating home health agencies (HHAs) when rendering home health services for Medicare beneficiaries. These workshops will advise providers on the process for submitting documents in support of the final claim.

The following topics will be covered during the workshop:
1.    Home Health Pre-Claim Review Model Overview
2.    Home Health Type of Bills (TOBs) and Healthcare Common Procedural Coding System (HCPCS) Codes Subject to the Home Health Pre-Claim Review Model
3.    Number of Home Health Benefit Period 60-day Episodes of Care
4.    Submitting a Home Health Pre-Claim Review Request
5.    A Provisionally Affirmed Decision
6.    A Non-Affirmation Decision for Incomplete Requests
7.    Resubmitting a Home Health Pre-Claim Review Request
8.    Claim Submission Where Home Health Pre-Claim Review Was Sought
9.    Claim Submission Where Home Health Pre-Claim Review Was Not Sought: The Prepayment Review Process
10.    Claim Appeals

Location Details:

McAllen | Oct. 11

San Antonio | Oct. 13

Houston | Nov. 16

Westin Galleria Houston
8:30am - 11:45am
Special Details
: This workshop will be a part of TAHC&H’s HCSSA Administrator Program. Multiple educational sessions are available on November 14-15 (additional fee will apply)

**Overflow Hotel
Information Coming Soon




Dallas | Nov. 17

DoubleTree Hotel Dallas Near the Galleria
8:30am - 11:45am

$139 Discounted Hotel Rate
Call Caitlin at 972-419-7607
**Ask for "TAHCH Rate."
Rate good while availability lasts!