By: Dexter Braff
It’s been said that when “the Fonz” jumped over a shark on water skis, it was the beginning of the end for “Happy Days.” And thus, the phrase “jumping the shark” was born to mark the point at which something goes from reasonable to ridiculous.
Well, at the risk of being targeted by the IRS, we think it’s time to point out that perhaps CMS has “jumped the shark” with its blind embrace of Pre-Claim Review (PCR).
Currently underway in Illinois (and slated to roll out to Florida, Texas, Michigan, and Massachusetts over the coming months), under PCR, agencies are required to submit all the requisite paper work for review in advance of submitting a claim for reimbursement.
No problem.
Except they failed to specify exactly what was required to gain approval – CMS’s version of “double-secret probation.”
Already obscenely burdensome documentation became even “burdensome-er.”
Data emerged showing that 11 weeks into the demo, nearly 30% of 230 plus providers had denial rates of 100% (you’d think they’d get lucky at least once); 54% had denial rates of 50% or more.
But perhaps worst of all, even if the PCR process improves, it appears to be a solution in search of a problem. After all, with all the other contortions a provider must undergo to squeeze a claim through an ever-narrowing bottleneck of paper, and coding, and sign-offs (oh, my), it’s not as if anyone gets reimbursed on their good looks.
Perhaps it’s no surprise, then, that, at least for the time being, mergers and acquisitions have jumped the shark in Illinois.
Which begs the question: will CMS do an about face-to-face?
Bueller? Bueller?