Home Health Agencies in Illinois will be subject to pre-claim review effective for episodes beginning June  1, 2019.  The pilot program will last 5 years. Agencies will receive a letter from PGBA with results from round 1 that ended in March 31, 2017 and must make an  irrevocable selection of options by May 16th, 2019.

CMS identified 54 agencies that closed as result of Pre-Claim and Medicare payments were reduced by $80M

Medicare Training and Consulting assisted providers successfully get through the process in 2016. Documentation is the key to getting claims paid and avoiding a 25% reduction in reimbursement.

James E. Plonsey, President of Medicare Training & Consulting, has been involved in healthcare accounting and finance since 1980. He has been a member of the Healthcare Financial Management Association since 1983. Jim is well versed in all aspects of Medicare and Medicaid participation and reimbursement. His background includes experience with providers, with the Blue Cross Association, with a major teaching hospital, and with a major accounting firm; prior to starting his own firm, Medicare Training & Consulting, in 1990. Jim also organizes and conducts seminars on a variety of issues concerning reimbursement.

James Plonsey has over 30 years of healthcare experience including six years with Blue Cross Blue Shield Association, training 750 Medicare auditors for the Fiscal Intermediary. He has owned a Home Health, West Valley Home Health in Utah.

Dana Eichler has 25 years in home care, previously supervised Quality Assurance Department for a large agency with over 800 patients, BS, specializing in billing audits, working knowledge of multiple Point-of-Care software packages, an expert in regulator and JCAHO issues. Dana is also one of our specialized retroactive / prospective CLIA trainers. She also a Certified Oasis Specialist-Clinical.