Home Health & Hospice Week

If you’re wondering how the 5 percent spot check option will work under the Review Choice Demonstration, a newly updated frequently asked questions set from Medicare can tell you.

HHAs may elect the spot check option only once they’ve hit a 90 percent affirmation threshold under RCD for six months. Or in Illinois, they were able choose it if they reached such a rate under the previous Pre-Claim Review demonstration.

Under the option, “Palmetto GBA will suspend 5 percent of claims over a 6 month period for prepayment review,” the Centers for Medicare & Medicaid Services explains in the updated FAQs. “The 5 percent is based upon a provider’s claim submission average from the previous 6 months.”

See the expanded 108-question set at 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 — scroll down to the “Downloads” box.