April 5, 2017 | Net Health

3 min read

Pre-Claim Review and CoPs are delayed. Here’s what you can do.

If you’re wading through the sea of breaking news surrounding the recent delays of pre-claim review and conditions of participation (CoPs), consider this your ticket out of the (icy) water.

We’re breaking down the ocean of info on both regulations, so you don’t have to waste time searching for answers. Follow the steps below to make these delays work to your agency’s benefit!

Know the basics

Implementing an effective strategy starts with understanding what’s going on. You don’t need to know every detail, but basic knowledge about these regulations, and why they’re being delayed, will empower you to plan effectively.

Pre-Claim Review
On March 31, CMS announced that as of April 1 the pre-claim review demonstration will be paused in Illinois for 30 days and will not expand to Florida on April 1. This news comes on the heels of home health providers and industry associations expressing major dissatisfaction with the pre-claim review demonstration, which they believe will place an enormous strain on home health agencies and interrupt patient care. If, when, and how the demonstration will resume remains to be seen, but CMS committed to let providers know of any updates at least 30 days in advance via their website. In the meantime, CMS stated that “home health claims can be submitted for payment and will be paid under normal claim processing rules.”

Conditions of Participation
The final rule CMS issued in January 2017 contained changes to the CoPs for home health agencies, which were slated to go into effect on July 13, 2017. Home health providers and associations, including NAHC, felt that the July implementation date was unrealistic, and expressed those feelings to CMS. On April 3, CMS responded by posting a proposed rule in the Federal Register that recommends delaying the implementation date for six months. This proposed rule could be made final pending a 60-day comment period, which ends on June 2.

Use the time wisely

Since the delays give you time to evaluate whether you’re truly equipped to meet the new demands of pre-claim review and CoPs, use it to consider how your EMR software vendor is planning to help you comply with these regulations. The secret to navigating changes to the pre-claim review demonstration and CoPs is partnering with a vendor that has structured their solution to deliver high quality care while maintaining productivity standards and mitigating risk.

If you’re wondering whether your home care EMR software vendor is the best fit for your agency, download our buyer’s guide to uncover the main areas of risk you may not be considering given the current regulatory frenzy.

Spread the word

Sharing helpful resources with your colleagues and your staff is the easiest way to arm them with the information they need to continue to provide quality care. Check out these resources:

Pre-Claim Review


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