What is the Review Choice Demonstration?
The Review Choice Demonstration (RCD) is intended to protect Medicare funds by offering options for a home health agency to submit compliant payment requests. RCD increases the likelihood that appropriate payments will be made at the correct time for home health services.
Review Choice Demonstration should also reduce the number of Medicare appeals, and improve overall provider compliance with Medicare program requirements.
The demonstration impacts Home Health Agencies (HHAs) in the states of Illinois, Ohio, North Carolina, Florida and Texas that bill to Palmetto GBA. When creating the claim, be sure to include the National Provider Identifier (NPI), CMS Certification Number (CCN), name, and address of the rendering provider.
North Carolina and Florida have actions that need to be taken now.
Let’s dive in.
What Home Health Providers in North Carolina and Florida Need to Know NOW!
If you are a Home Health Provider in North Carolina or Florida, full implementation of the Review Choice Demonstration will be in effect as of September 1, 2021. Welcome to the mid-cycle selection period: August 1-15th, 2021!
If you are part of an association, like HCAF, there are many additional resources but here are the important points.
Cycle 2 Selection Options for Home Health Agencies
If your agency made a selection for Cycle 2 in April and do not want to change option, you do not need to take any action.
If your agency made a selection for Cycle 2 in April and want to change your selection, NOW IS THE CHANCE! Your choices are based on your Cycle 1 results.
Cycle 2 Options are Based on Your RCD Cycle 1 Results
If the provider’s affirmation rate for Cycle 1 is greater than or equal to 90% with at least 10 pre-claim review requests, they can select:
Choice 1: Pre-claim review (PCR)
Choice 4: Selective Post payment review or
Choice 5: Spot Check Review. If you select Choice 5 (Spot Check), your claims will ADR (Additional Documentation Request) at the normal rate.
What if you are lower than 90%?
If the provider has a less than 90% affirmation rate or they have not had decisions for a minimum of 10 pre-claim review requests for Cycle 1, they must choose from one of the initial three options.
Choice 1: Pre-claim Review
Choice 2: Post Payment Review
Choice 3: Minimal review with a 25 percent payment reduction
If you are a provider that did not make a Cycle 2 selection and you do not make a selection by the August 15th deadline, you will default to Post Payment Review (100% of your claims will be reviewed!) or Selective Post Payment Review based on your Cycle 1 Results.
Submitting Claims
Claims with dates of service on or after August 31, 2020(!!!!) that are submitted on or after 9/1/21 without a pre-claim review decision on file will be pulled for pre-payment review but will not be subject to the 25% reduction during that period for 90 days.
Ready or not, September 1st is coming and RCD will be in full effect!
Cycle 2 will end of October 31, 2021 (Be sure to get your costume to celebrate!)
Additional Resources:
Pre-Claim Review Initial Episode Checklist
Pre-Claim Review Subsequent Episode Checklist
Additional Information can be found at the CMS website.
