Pre-Claim Review Demonstration for Home Health Services Expands to Florida Ask-the-Contractor Teleconference
View the handout for the February 28, 2017, Pre-Claim Review Demonstration for Home Health Services Expands to Florida ACT.
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- Will agencies be able to submit the request and documentation electronic to CGS?
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Yes, you can through the myCGS web portal.
Added: 03.31.17
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- Are additional signed verbal orders such as new meds, changes in services, treatment frequency or duration that are received after the start of care also required to be submitted?
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Yes, they are.
Added: 03.31.17
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- Will the Pre Claim Review cover sheet be revised to include the ability of the agency to identify page numbers?
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That revision is not available at this time, but we will keep the idea on the table for further revisions.
Added: 03.31.17
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- What education has been done for the physicians and the referral sources related to PCR?
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We do understand that's a frustration, and we are working with the Part A and Part B Medicare Administrative Contractors (MACs) to join together to educate physicians and their staff.
Added: 03.31.17
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- Do all discipline visit notes for services provided up to the date the PCR request is submitted need to be sent?
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Yes, they do. Also, please send in all referral documentation.
Added: 03.31.17
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- What is meant by initial orders referenced on the CGS PCR request cover sheet?
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The initial orders for home health to evaluate and treat.
Added: 03.31.17
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- Does the face-to-face encounter note need to be separated from the referral documentation as a stand-alone document?
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Yes, it does, and CGS encourages you to title that document "face-to-face". That's not considered altering the document. It's considered putting a title on the document. It's perfectly fine to hand write "Face-to-Face" as the title or your software should allow you to add a title to a document.
Added: 03.31.17
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- What does CGS prefer regarding a Table of Contents?
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CGS doesn't require a Table of Contents. What is helpful for us is if you have just a short summary letter. For example, if you put "Be sure and refer to the nurse's visit note for February 12th where the patient has a new wound.", or "the therapy visit note for January 15th, where the patient fell while the therapist was present".
Added: 03.31.17
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- Regarding the response on the affirmation and non-affirmation. I know you're going to send letters if we send letters. You're going to fax if we fax, but if we do the ESMD, will you be able to provide an electronic response for affirmation or non-affirmation?
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If you submit your Pre-Claim Review using ESMD, you will receive your response via ESMD. We will also issue out a letter as well to let you know if it's non-affirmed or provisionally affirmed.
Added: 03.31.17
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- Could someone explain a little bit more about the comment made toward the end regarding verbal orders and other supporting documentation which is signed by the physician and returned to the agency, that that needs to be submitted with the PCR?
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The verbal orders don't have to be signed for the Pre-Claim Review, but they do need to be signed before you submit for billing.
Added: 03.31.17
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- This is a question regarding provisional affirmations. Can you talk to us a little bit about that process as far as for the decision that may come later through an ADR? Is it still subject to ADR, because it's provisional? We're trying to define what provisional means?
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One intention of Pre-Claim Review is to eliminate some of that back and forth with ADRs, so, generally, if you go through the Pre-Claim Review process, you shouldn't receive an ADR request. The only time we believe providers would see ADR requests, associated with the PCR process, is for providers who are supposed to submit a Pre-Claim Review and do not. In this situation, the final claim would be stopped for an ADR Prepayment Review.
Added: 03.31.17
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- In working with Palmetto, if we are faxing in information, we have separate tasks for cover sheets that we have to put on top of each section. Is that going to be the same thing that would be required if we fax in a record with CGS?
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No. It is not the same with CGS. We don't have the tasks and the different options. Please refer to the myCGS User Manual in the resources section of the presentation, where it will give you step by step instructions, but it's basically uploading your documentation, and that's it. It's not an extensive process at all.
Added: 03.31.17
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