“Finally Friday!” Preview of the Pre-Claim Review Demonstration for Home Health Services

FRIDAY July 8, 2016:

“Preview of the Pre-Claim Review Demonstration for Home Health Services


Is this perhaps a preview of what we might expect them to do in the future with other types of claims… like Inpatient claims at Acute Care Hospitals??

Learn How CMS Plans to Reduce
a 59% Error Rate

And we discuss: is this a view of the future?

Watch for the Handouts

Sponsored by The Health Law Partners, MAS Coding Solutions

Joe Osentoski, BAS, RN-BC is a clinical consultant with A.D. Maxim Consulting, specializing in ADR appeals and has been a Registered Nurse for over 20 years.

THIS WEEK, we invited a clinical consultant to join us, Joe Osentoski, BAS, RN-BC, from A.D. Maxim Consulting. He has worked for 20 years as a clinical consultant in home health and hospice, and has extensive experience with multiple Medicare audits, pre-pay probes, compliance audits and targeted medical reviews. He has completed over 5,000 Additional Development Requests (ADR’s) in home care and hospice, filed 1000’s of appeals, and has had more than 1,000 claims resolved at the ALJ level, with a 90% success rate.

Joe comes to us via reference of Former ALJ Bob Soltis, a veteran of our shows. Joe appeared before Judge Soltis on many occasions and impressed the Judge with his knowledge, preparedness and straight-shooting style.

Legendary rascal, former ALJ, author, and speaker on Medicare, hearing strategy, presentations, ethics, the art of advocacy, Bob is the founder and CEO of the Advocacy Akademie. In other words, he belongs on our faculty.

Bob Soltis, Former ALJ, author of “How to Handle Your Medicare Hearing

We asked Joe and Judge Soltis to come speak with us about CMS’ new Pre-Claim Review Demonstration of Home Health Services, just announced on June 8 2016. A quick look at the project may give you chills, realizing that CMS might find this a more successful model for reducing denials and appeals than any other planned projects. And if it does succeed, what might that mean for hospitals, and not just Home Health Agencies?

So here’s what we will be discussing on our show:

    • A short review of what the Demonstration does for Home Health Agency processes
    • Are there any regulatory changes?
    • Will this really help the OMHA Backlog, as CMS claims?
    • Is this “the same ol’ same ol'” manual review process?
    • Will this really be more of a help or a hinderance?

So join us, share your own insights and bring your questions for us!

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FRIDAY – 1:00PM to 2:00PM EDT

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Handouts for This Show


Pre-Claim Review FAQ PGBA 6-24-16 48.59 KB 37 downloads



CMS PCRD HH Operational Guide 6-24-16 117.88 KB 34 downloads


Video Replay of Today's Show

CCMA CMAS CEU Certificate


CMAS 1.0 CEU FF Pre-Claim Reviews 109.91 KB 27 downloads


Video Replay of LAST WEEK's Show

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Visit the archive of ALL PREVIOUS SHOWS with handouts & video

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