Home Health & Hospice Week

Here’s how results calculation works.

Some Illinois agencies were placed in the wrong review choice category due to incorrectly calculated results from the first six months of RCD — but the problem should be fixed now.

“Cycle 1 results for approximately 25 percent of Home Health Agencies (HHAs) who selected Option 2 or Option 5 were incorrect,” HHH Medicare Administrative Contractor Palmetto GBA said in a recent post on its website. They are both post-pay review options. “In these cases, some of the full pay claims were calculated as partial pay, thus inadver­tently lowering their claim approval rate.”

The MAC has already generated any new results letters required by the error, updated the information on its portal, and called providers who ended up with a new set of options to select from due to the change. “Most of the providers in this group will remain with the same set of review choice options as indicated in their original results letter,” Palmetto adds.

Other RCD developments include:

• Timeline clarification. Palmetto has provided more details about the time periods it uses to calculate RCD results. “For those options that are evaluated every six months, the claims or PCR requests reviewed during the cycle will determine the provider’s results. Providers will continue in their selected option during the evaluation and selection period,” the MAC says in a new post to its website. “The evaluation period occurs during month seven. At the end of month seven, providers will be able to select their option during a two-week window. Results letters will be sent to providers by the end of the seventh month, 30 calendar days or 20 business days from the end of the review cycle.”

For example: Illinois had its first six months of RCD from June 1, 2019 to Nov. 30, 2019. Palmetto performed its Cycle 1 analysis in December 2019, notified providers by Dec. 30, and Illinois agencies could make their selections for Cycle 2 from Dec. 31 to Jan. 13. Cycle 2 begins Feb. 1 and will run through July 31.

• Changing review methods. If you’re an Illinois agency that is changing review methods between Cycles 1 and 2 of RCD, pay attention to any changes to your submission process. For example, if you’re switching from Post-Pay Review to PCR, you’ll need to start adding Unique Tracking Numbers (UTNs) to claims you submit, Palmetto explains on its website.
• Keep dates straight. Even though HHAs may have made a new RCD review choice, they can’t switch to it until the next cycle begins. And inclusion is based on claims submission dates, not service dates. For Illinois providers, that means they should begin submitting requests or claims “on 2/1/2020 for ANY claim that will be submitted on or after 2/1/2020 with a date of service on or after June 1, 2019,” Palmetto explains.

Note: To keep on top of RCD information, check out Palmetto’s RCD website by going to www.palmettogba.com, clicking on “Jurisdiction M Home Health and Hospice MAC” in the right-hand column, then clicking on “Review Choice Demonstration” in the green “Top Links” box on the left.