Pre-Claim Review (PCR)

A Medicare Pre-Claim Review (PCR) is a process that requires home health agencies to submit documentation to Medicare before submitting a claim for payment. This process is intended to help prevent fraud and abuse in the home health industry by ensuring that claims are supported by appropriate documentation.

Under the PCR process, home health agencies must submit documentation to Medicare before providing services to a patient. Medicare will review the documentation to determine whether the services are medically necessary and meet all applicable requirements. If Medicare approves the claim, the agency can proceed with providing the services and submitting the claim for payment. If the claim is not approved, the agency may need to make additional changes or provide more documentation before resubmitting the claim.

The PCR process can be complex and time-consuming, and many home health agencies struggle to navigate it successfully. That’s where Hummingbird Home Care Consulting can help. Our team has extensive experience in helping providers prepare for and navigate the PCR process, ensuring that claims are processed and paid in a timely manner. Contact us today to learn more about how we can help your home health agency succeed.