Home Health & Hospice Week

The end of the Review Choice Demonstration phase-in period for Florida and North Carolina home health agencies is right around the corner on March 31.

With Cycle 2 starting on May 1 in those states, HHAs should consider submitting 10 RCD claims now so they can have expanded options for review in that cycle. “If the HHA’s full affirmation rate for Cycle 1 is 90 percent or greater (based on a minimum of 10 pre-claim review requests), the HHA may select one of the three subsequent review choices,” RCD contractor Palmetto GBA explains on its website — Choice 1: Pre-Claim Review (PCR); Choice 4: Selective Postpayment Review; or Choice 5: Spot Check Review.

Choices 4 and 5 are a much lighter review burden, experts note.

“If the HHA’s affirmation rate is less than 90 percent, or they have not received decisions for at least 10 PCR requests, or they were in Choice 2 — 100 percent Postpayment Review during Cycle 1, the HHA must again choose from one of the initial three options” and is not eligible for the lighter Choice 4 or Choice 5 option, Palmetto reminds agencies.

While Cycle 2 starts May 1, Cycle 1 actually ends Feb. 28, so HHAs that want to take part in the 10-claim review should hop on it, Palmetto emphasizes in the article titled “Get Your 10 In.”

Mark your calendar: All providers in North Carolina and Florida must make review selections for Cycle 2 in the window from April 1 to April 15, Palmetto says.