This minute covers the update for Florida and North Carolina Home Health Review Choice Demonstration (RCD). Palmetto GBA provides HHAs with a wealth of information addressing the requirements and expectations of the RCD.
Hello Everyone and Welcome to our Monday Minute. Today I want to share some information with you that we have just learned. The state of Florida and the state of North Carolina will be 100% required to participate in the Review Choice Demonstration beginning September 1, 2021. With this 100% participation, the Review Choice Demonstration has options for you to select from, with the majority of agencies selecting the Pre-Claim Review (PCR) option, which requires 100% of your 30-day claims to have gone through the Pre-Claim Review process in the submission of a portion of your records, including a signed plan of care. Once it’s gone through that PCR review, if it passes, it will be affirmed and you will be provided a UTN number, a unique tracking number that has to be put on your final 30-day claim in order for you to be paid. There is the opportunity for you to resubmit that information, if it is not affirmed in the first round, and you should continue to do so. 100% participation is for every Medicare certified agency in the state of Florida and North Carolina.
The other three states that are also participating in the Review Choice Demonstration are now going back to them implementing the requirement of a 25% decrease in payment when you have submitted a final claim where it did not get Pre-Claim Reviewed. They will then send you an ADR and if they approve the ADR review, you will receive a 25% reduction in payment. That is being reinstated on September 1st, as well. From August 1st to August 15th, the agencies in Florida and North Carolina are required to go into the portal with Palmetto GBA and select an option for you to participate in during the Review Choice Demonstration. The Pre- Claim Review option again being the most common, they will put you into a default category if you do not make a selection by August 15th.
If you need additional information about the Review Choice Demonstration, we will provide in this Minute, the link to the Palmetto GPA portion of their site that specifically addresses the Review Choice Demonstration. We also have recorded webinars and your state associations have those as well. Thank you all for participating today. Thank you most importantly for continuing to take care of patients during this Public Health Emergency that was just extended for another 90 days as well, so into October. It’s a very important time in our country and we do appreciate so much the care that you are providing on the front lines of our patients. Thank you again for participating today and I hope you have a fabulous week.
Links to Reference:
REGISTER HERE for: NAHC FMC21