WASHINGTON, D.C. (July 29, 2019)—The Centers for Medicare & Medicaid Services (CMS) announced on Monday that the Review Choice Demonstration (RCD) would begin in Ohio on Sept. 30, 2019. In the same announcement, CMS said it anticipated 60 to 90 days between beginning the demonstration in the remaining states of Texas, North Carolina and Florida. The RCD began in Illinois on June 1.
Medicare-certified home health agencies (HHAs) in Ohio will have from Aug. 16, 2019 to Sept. 15, 2019 to make their RCD selection via the Palmetto GBA portal. Ohio providers who are not registered for the portal should do so. Any provider who does not make a choice by Sept. 15 will be automatically placed in Choice 2: Post-payment Review.
HHAs will initially select between three review choices:
- Choice 1: Pre-Claim Review,
- Choice 2: Post-payment Review, or
- Choice 3: Minimal review with a 25% payment reduction. (HHAs that select this choice will remain in this choice for the duration of the demonstration regardless of their claim approval rate).
Home health providers who select either choice 1 or choice 2 will be evaluated for six months. If the providers’ full affirmation rate or claim approval for those six months is 90% or greater (based on a minimum of 10 submitted pre-claim review requests or claims), the provider may request three subsequent review choices:
- Choice 1: Pre-Claim Review,
- Choice 4: Selective Post-payment Review, or
- Choice 5: Spot Check Review.
HHAs that do not actively choose one of the subsequent review options will automatically be assigned to participate in Choice 4: Selective Post-payment Review, and will remain there for the duration of the demonstration.
HHAs under a Targeted Probe & Educated (TPE) review will be removed from the TPE when the RCD begins. Providers under a UPIC audit are not eligible for the RCD, however providers under UPIC review should still make an RCD choice during the selection period.
Find addtional information on the Palmetto GBA RCD information page. And read HomeCare’s previous RCD coverage here.
