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The Office of Management & Budget (OMB) officially approved implementation of the Review Choice Demonstration in Home Health. We are currently awaiting an official notification of a start date for Illinois from The Centers for Medicare & Medicaid Services (CMS).

Review Choice Demonstration (RCD) for Home Health Services will give providers in the demonstration states an initial choice of three options:

  • Pre-Claim Review (PCR)
  • Postpayment Review
  • Minimal Postpayment Review with a 25 percent payment reduction for all home health services

If the HHA’s full affirmation rate or claim approval rate is 90% or greater for a minimum of 10 claims or requests for the 6-month period, they may choose one of the subsequent review options:

  1. Start or continue participating in PCR for another 6‐month period
  2. Selective postpayment review of a statistically valid random sample (SVRS) of claims every 6‐months, for the remainder of the demonstration; or
  3. No review, other than a spot check of 5% of their claims every 6 ‐ months to ensure continued compliance

CMS will implement the demonstration for the Home Health and Hospice Medicare Administrative Contractor Jurisdiction M (Palmetto GBA) providers operating in:

  • Illinois
  • Ohio
  • North Carolina
  • Florida
  • Texas

The demonstration will span five years, with the option to expand to other states in the Palmetto GBA JM Jurisdiction.

Updates to RCD: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Review-Choice-Demonstration-for-Home-Health-Services.html

Frequently Asked Questions about RCD: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Downloads/RCD-FAQs-for-the-Proposed-Collection-of-Information.pdf

Join HPS on Friday, March 15, 2019 for an in-depth webinar regarding the requirements of the Review Choice Demonstration (RCD) and how agencies in the aforementioned states should be preparing for the implementation.

REGISTER HERE