Home Health & Hospice Week

Keep an eye out for ongoing revisions.

If your home health agency operates in one of the six current Review Choice Demonstration states, you have new instructions to review. And they will likely be the first of many modifications.

In articles posted on May 23 and 24, RCD contractor Palmetto GBA renumbers the demo’s review options and lays out newly extended cycle dates.

HHAs are now down to four review choices, since the Centers for Medicare & Medicaid Services has removed the “Choice 3: Minimal Review with 25% Payment Reduction” review option. Now, the renumbered review choices are:

• Choice 1 — Start or continue participating in pre-claim review (PCR) for another cycle
• Choice 2 — 100 percent postpayment review
• Choice 3 (renumbered from 4) — Selective postpayment review of a statistically valid random sample (SVRS) of claims every six months for the remainder of the demonstration
• Choice 4 (renumbered from 5) — Spot Check Review of 5 percent of claims every six months to ensure continued compliance.

How it works: “If an HHA’s full affirmation rate or claim approval rate is 90 percent or greater for the previous six-month period,” the provider may opt for choices 1, 3, or 4, Palmetto explains in three updated articles (Illinois, Texas, Ohio) and two new articles (North Carolina and Florida, Oklahoma). If it’s under 90 percent, agencies must pick between choices 1 and 2.

Palmetto also lays out updated and new cycle dates (see chart below).