Hello, everyone, and welcome to our Monday Minute.
Today we’re going to discuss the Review Choice Demonstration and the process and cycle that is happening right now within the five states that are involved in the Review Choice Demonstration. The Review Choice Demonstration includes that agencies can select different options to participate in this review. Pre-Claim Review seems to be the most prevalent, and definitely the one you want to start with, if you’re new to the process. Pre-Claim Review includes sending in additional information, or I should say, initial information to be medically reviewed and affirmed prior to you being able to bill the final claim. There is also a portion, once you get into the process, that you can select to have Post-Payment ADR Reviews completed. Understanding that at the end of each cycle, there’s a calculation made and if your affirmation rate is 90% or greater, then you are allowed to select a different set of options for the next cycle. If your calculation of affirmation rate is less than 90%, then you’re held to the Selection 1 categories of selection for the next round.
We’re discussing this today, because of the fact that Florida, North Carolina, and Ohio have just ended their cycles. Ohio has just ended cycle four; Florida and North Carolina have just ended cycle three. Their final reports should have been posted on July 31, showing the calculations for those cycles, and their selection period for the coming cycle is from August 1 through August 16. If a selection is not made by August 16 in the PCR Portal (or RCD Portal), they will make a selection for you. So, you need to make positively sure that whoever is in charge, in your organization, of the PCR or RCD selection period, that they make that selection during that time period, based on the scores on the posted reports of your results from the previous cycle. Texas and Illinois are the other two states involved, and they’re currently in the middle of their cycles; Illinois in cycle five and Texas in cycle four, which if I’m calculating correctly, will end in September.
I want to thank you all for participating today. As always, if you have any need for Healthcare Provider Solutions to assist, we would be happy to do so. Thank you all for caring for patients during this very tumultuous time; and please stay tuned to your state and national home care and hospice associations for all the information and activities, especially in those five states that are participating in the Review Choice Demonstration, as they constantly post and send out updates on that process.
Thank you again and I hope you have a fabulous week.