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Altamash Mir HealthCare consultant

Get to know all bout Pre-Claim Review for Home Health Agencies Documentation Requirements.

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Altamash Mir HealthCare consultant

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  1. Pre-Claim Review for Home HealthAgenciesDocumentation Requirements altamashmir.com

  2. Home Health Agency must know: • Pre-claim Authorization is needed for ALL New Patients (SOC’s) & any patients being Re-certified (Recerts) after the implementation date. • Agencies could send pre-claim authorization requests two weeks prior to the implementation date. • Agencies can send requests anytime between the SOC & the end of episode, but before submission of the final claim of that episode. • Agencies cannot put patient care on hold, while waiting for Pre-claim authorization request decision! You are still held liable for a patient that has been admitted to your agency! • Utilize the form that we have developed to send your Pre-claim authorization requests (email to request)

  3. Process for submitting requests: • Receive orders from the MD to see a patient • Have the Physician/Practitioner provide the Agency with a Face to Face Evaluation of the patient • Evaluate the patient (SOC or REC) & develop a plan of care (485) • Have the Physician/Practitioner review & sign the plan of care • Review & Complete the “Pre-Claim Review Request Form” • Attach the required information & upload (preferred), fax or mail the information to your MAC • Keep a record of all claims submitted tracking sheet & follow up on requests submitted 10 or more days ago diligently on a daily basis • Once a UTN (Unique Tracking Number) has been assigned to an approved claim, enter the UTN on your tracking sheet (you’ll need it at final billing). CMS has stated that they will try their best to issue the “Provisional Affirmative or Denial Decision” letters to providers within the 10 days of the submission of requests • Submit Final Claim upon the end of the episode with the UTN number on UTN in field locator 63 of a paper claim 1450 (UB-04), further guidelines are being awaited for Electronic Claims

  4. How to deal with Denials • If a pre-claim authorization request has been denied, the Home Health Agency may re-submit the request with the supporting documents to satisfy the requirements. • The MAC’s will have 20 days to review the re-submitted documentation & get back to the provider. A provider is allowed an unlimited number of resubmissions for pre-claim review requests that have not been affirmed.

  5. Contact Us: Contact us to get more information or visit our website: http://altamashmir.com/

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