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Overview of CMS Webcast on Review Choice Demonstration

Posted on Monday, November 19, 2018 1:30 PM

This week, CMS hosted a webcast giving an overview of Review Choice Demonstration for home health services. 

“CMS will implement a 5-year Review Choice Demonstration (RCD) for the Home Health agencies in the states of Illinois, Ohio, North Carolina, Florida, and Texas, with the option to expand to other states served by Palmetto GBA.  CMS plans to begin the demonstration in Illinois no earlier than December 10, 2018, with the Demonstration phased into the other states with at least 60 days notice before implementation. Because CMS has yet to receive clearance from the Office of Management and Budget for the demonstration, the implementation date may be delayed beyond December 10.”

The choices are:

  • Pre-claim review of all claims that allows unlimited resubmissions of non-affirmed requests and allows for multiple episodes to be requested on one pre-claim review request for a beneficiary.
  • Post-claim reviews of all claims submitted. Agencies will follow its standard intake, service, and billing procedures, and the claims will pay according to normal claim processes.
  • Includes a minimal review with payment reduction. All home health claims receive a 25 percent payment reduction.
  • After six months, the MAC will select a Statistically Valid Random Sample (SVRS) for post payment review.
  • The MAC will randomly select five percent of the submitted claims for prepayment review every 6 months. The HHA may remain with this choice for the remainder of the demonstration if the spot check shows the HHA is compliant with Medicare rules.  If the HHA is not in compliance, the HHA must select again from one of the initial three review choices.

Source: NAHC Report


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