It’s ba-a-a-c-c-k-k ! Review Choice Demonstration returns!
If you are a home health provider in Illinois, North Carolina, Ohio, Florida or Texas, CMS will “discontinue exercising enforcement discretion” for the Review Choice Demonstration for Home Health Services beginning on August 3, 2020, regardless of the status of the public health emergency.
The initial choice selection period will begin in North Carolina and Florida on August 3, 2020 and end on August 17, 2020. It is critical that you make a choice selection during this time period to avoid being placed in the default choice! (Selman-Holman recommends Pre-Claim Review!)
The choice selection period for Ohio’s second review cycle will also begin August 3, 2020 and end on August 17, 2020.
Texas agencies: You will resume under the initial choice you made back in February.
Following these choice selection periods, home health claims in all demonstration states (Illinois, Ohio, Texas, North Carolina, and Florida) with billing periods beginning on or after August 31, 2020 will be subject to review under the requirements of the choice selected. This includes pre-claim review, pre-payment review, and post-payment review.
Billing periods, NOT episodes! That means if you have a 60-day episode that began August 1, the second billing period in that episode begins August 31 and that second billing period in the episode is subject to the review.
Selman-Holman has been assisting agencies with pre-claim review and post-payment review since the inception of the Review Choice Demonstration. We have a knowledgeable team that can assist you in the development of your own processes or we can ready the records for you for submission. In addition, Palmetto offers a series of Monthly Review Choice Demonstration (RCD) webinars free of charge, but you do need to register in advance to attend. These webinars will provide up-to-date RCD information and give you a chance to ask any questions you may have about RCD. Each webinar session will be held from 11 a.m. to 12 p.m. ET.
It is highly recommended that you take advantage of this opportunity to hear directly from Palmetto on the latest RCD information.
Here are the upcoming webinar dates and registration links:
Following the resumption of the demonstration, Palmetto will conduct post-payment review on claims subject to the demonstration that were submitted and paid during the pause. What does this mean?
- If you are with an agency in IL, OH or TX and continued to submit your records for PCR during the pause, you will not be subject to the post-payment review process for any claim you submitted with a UTN.
- If you stopped the PCR process, every claim your agency submitted without a UTN will be subject to post-payment review (i.e. ADRs).
CMS will post more information on the post-payment review process in the near future.
If your agency achieved the required affirmation rate of 90%, first, congratulations! You are on to the next round. For round 2, most agencies choose a random 5% ADR option. Selman-Holman can assist with preparing those charts for the ADR process and any appeals that are necessary. Contact Selman-Holman today to set up a consultation!