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Review Choice Demonstration Deadline – May 16 and Project Update

Posted on Monday, May 20, 2019 12:30 AM

Illinois home health agencies have until Thursday, May 16, 2019 to choose their RCD choices.  HHAs that do not make a choice selection by this date will be automatically placed in either Choice 2: Post-payment Review (for those IL providers new to RCD or not having an affirmation rate of 90% or greater) or Choice 4: Selective Post-payment Review (for those Illinois providers with an affirmation rate of 90% or greater (based on a 10 request/claim minimum).

As a reminder, Review Choice Demonstration is the newer version of the strict pre-claim review procedures. Providers who previously faced a 25% payment reduction for home health services are now able to choose from either 100% pre-claim review/100% post-payment review or face a 25% payment reduction.

“There are several more important items of note relative to the RCD below:

  • A HHA’s affirmation rate is calculated on the initial submissions and any resubmissions. If a provider believes they have an incorrect calculation they are to contact the Palmetto PCC and request a review of the calculation.
  • Palmetto GBA has indicated that HHAs under a Targeted Probe & Educate (TPE) review with Palmetto will be removed from the TPE when the RCD begins in their state and after the provider has completed the TPE round it is in when the RCD begins. Providers will not be under both reviews simultaneously. Additionally, an HHA under a UPIC (Unified Program Integrity Contractor) is not eligible for the RCD. Any such providers may receive a letter from Palmetto indicating this. If the RCD is occurring in their state when the UPIC review is completed, the HHA will need to make an initial RCD choice. This does not mean claims that are part of the RCD will never be reviewed by a UPIC. They may be subject to UPIC review if fraud is suspected. Also, claims may be selected as part of the CERT (Comprehensive Error Rate Testing) sample. Again, claims falling under RCD will be excluded from regular MAC TPE reviews.
  • CMS has published a RCD HH Operational Guide that all providers effected by RCD should review. There are also several other helpful resources for RCD available from Palmetto. They are located at the Palmetto GBA Home Health Review Choice Demonstration webpage.”

Source: NAHC Report

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