Home Health & Hospice Week

Florida and North Carolina home health agencies, don’t miss out on your chance to change your RCD review option for the next cycle.

Recap: Review Choice Demonstration Cycle 2 ended on Oct. 31 in those states, and RCD contractor Palmetto GBA posted HHAs’ review results on Nov. 30, the HHH Medicare Administrative Contractor notes in a new post. Now if agencies achieved a full affirmation rate or claim approval rate of 90 percent or greater, they can chose a less burdensome, advanced review option for Cycle 3 that begins Jan. 1. The advanced options are Choice 4 (Selective postpayment review of a statistically valid random sample [SVRS] of claims every six months for the remainder of the demonstration) or Choice 5 (Spot Check Review of 5 percent of claims every six months to ensure continued compliance).

HHAs have until Dec. 14 to make their review choices for Cycle 3, Palmetto notes on its website. “If an HHA is eligible for a subsequent review option but does not make a selection during the selection period, the HHA will be placed in Choice 4,” the MAC offers.

RCD agencies with affirmation rates under 90 percent can select between Choice 1 (Pre-Claim Review), Choice 2 (100 percent Postpayment Review), and Choice 3 (minimal postpay review with a 25 percent reduction), Palmetto notes.