Home Health & Hospice Week

Home health agencies in North Carolina and Texas may feel like they have the hang of the Review Choice Demonstration by now, but they’ll pay a big price if they’re wrong.

Why? Beginning April 1, 2022, the Centers for Medicare & Medicaid Services “will implement the 25 percent payment reduction for home health providers in North Carolina and Florida, where applicable,” RCD contractor Palmetto GBA explains on its website. “Claims submitted on or after April 1, 2022 by providers in NC and FL that have selected Choice 1, and do not have a pre-claim review decision, or who selected Choice 3, will be subject to the 25 percent payment reduction,” Palmetto explains.

CMS initially held off on imposing the penalty “to help NC and FL providers transition to full implementation in the demonstration,” Palmetto recounts. Now, agencies under Choice 1 will have to make sure they get an affirmation and include the Unique Tracking Number on the claim.

Reminder: Choice 1 is pre-claim review and Choice 3 is minimal post payment review with 25 percent payment reduction. HHAs’ window for determining a new review selection for the next cycle closed on March 16.

The National Association for Home Care & Hospice “appreciates that CMS allowed agencies in North Carolina and Florida time to adjust to full implementation of RCD as was done previously in other states,” the trade group says.

Texas HHAs are starting Cycle 4 and Illinois HHAs are starting Cycle 5, Palmetto adds.