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Important CMS Review of RCD

Posted on Friday, November 30, 2018 2:14 PM

Earlier this week, CMS hosted an open-door forum on the new Review Choice Demonstration (RCD) that is set to begin on December 10, 2018 in Illinois.  The goal of this demonstration is to test improved methods for identifying, investigating, and prosecuting Medicare fraud occurring in the home health program while maintaining or improving the quality of care provided to Medicare beneficiaries.

The demonstration is scheduled to begin in Illinois on December 10th, with Ohio, North Carolina, Florida and Texas to follow.  The states listed above, minus Illinois, will all be given 60-day notice ahead of its implementation.  The only Medicare Administrative Contractor (MAC) affected by the demonstration is Palmetto.

RCD allows for home health care agencies to choose from three initial choices:

Choice I:

  • Pre-claim review of all claims
  • Follows process implemented under the initial Pre-Claim Review Demonstration
  • Allows unlimited resubmissions of non-affirmed requests
  • Allows for multiple episodes to be requested on one pre-claim review request for a beneficiary

    Choice II:
  • Post payment review of all claims
  • Follows current post payment medical review processes
  • Default option if no selection made

    Choice III:
  • Minimal review with payment reduction
  • All home health claims receive a 25% payment reduction
  • Claims are excluded from MAC targeted probe and educate review, but may be selected for Recovery Audit Contractor (RAC) review


Click here to view the presentation.

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