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CMS Announces Expansion of Review Choice Demonstration to More States

Posted on Monday, October 7, 2019 12:40 AM

CMS announced this week that Review Choice Demonstration (RCD) will begin in Texas on December 2, 2019.  They also announced that RCD will start in North Carolina and Florida on March 30, 2020.

Medicare certified home health providers in Texas will have from October 16, 2019 – November 14, 2019 to make their RCD choice selection via the Palmetto GBA eServices portal. Selections must be made through eServices so any Texas providers not already signed up for eServices should do so now.   Texas HHAs that do not make an RCD choice selection by November 14 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).

HHAs that do not actively select one of the initial three review choices will be automatically assigned to participate in choice 2, post-payment review.  Palmetto is sending letters to Texas HHAs detailing this information.

HHAs who select either Choice 1 or Choice 2 will be evaluated for 6 months. If the HHA’s full affirmation rate or claim approval for those 6 months is 90 percent or greater (based on a minimum of 10 submitted pre-claim review requests or claims), the HHA may select one of the three subsequent review choices:

  • Choice 1: Pre-Claim Review,
  • Choice 4: Selective Post-payment Review, or
  • Choice 5: Spot Check Review.

Source: NAHC


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