Home Health & Hospice Week

About 25 percent of the nation’s agencies will eventually be under RCD.

If you’re one of the approximately 1,500 HHAs that will start the Review Choice Demonstration in the next four months, you should learn a lesson from the pioneering state in the medical review demo.

In the first round of RCD, Illinois HHAs made these choices for their review method, RCD contractor Palmetto GBA told Eli last year:

Pre-claim review: 51 percent
Postpayment review: 25 percent
Minimal review (25 percent penalty): 0 percent
Selective postpay review: 9 percent
Spot check pre-pay review: 15 percent

But Palmetto has revealed that in Round 2, Illinois agencies have now made these choices:

Pre-claim review: 85 percent
Postpayment review: 1 percent
Min. review (25 percent penalty): 0 percent
Selective postpay review: 1 percent
Spot check pre-pay review: 13 percent

Judging from the stats change, Illinois agencies appear to be happy with the spot check pre-pay review option, since the percentage of providers choosing that method increased by 2 points to 15 percent. (Reminder: Spot check pre-pay review is an advanced option available only to agencies that have achieved a 90 percent or greater affirmation rate based on a 10 request/claim minimum in the previous quarter. For Illinois agencies, the previous PCR demo counted as a previous quarter.)

But providers have quickly realized that postpayment review is not desirable, judging from the new stats posted Jan. 15. The number of HHAs choosing postpay review and selective postpay review (an advanced option) fell markedly, from 25 percent to 1 percent for the former and 9 percent to 1 percent for the latter.

The advantage of choosing pre-pay review is that you can have multiple chances to get the documentation right with returned non-affirmed claims and corrections, experts point out.

Choosing the most advantageous RCD option will become even more crucial as hundreds of more HHAs begin the demo in coming months.

According to the latest Centers for Medicare & Medicaid Services data online at data.medicare.gov, about 2,840 Medicare-certified home health agencies operate in the five RCD states of Illinois, Ohio, Texas, North Carolina, and Florida. That’s 25 percent of the nation’s nearly 11,300 agencies.

Illinois (615 HHAs) began RCD last June, Ohio (757 HHAs) began Sept. 30, 2019, Texas (444 HHAs) is scheduled to begin March 2, and North Carolina (173 HHAs) and Florida (851 HHAs) are slated for May 4.

HHAs are still waiting to hear about the rate of claims that Palmetto is affirming under RCD, notes Joe Osentoski with Gateway Home Health Coding & Consulting in Madison Heights, Michigan. “Even now,” more than seven months into the demo, Palmetto hasn’t shared provisional affirmation rates, he notes.

That’s a contrast to RCD’s forerunner, the PCR demo, when Palmetto issued affirmation rates regularly.

Note: The list of Medicare-certified HHAs is at https://data.medicare.gov/widgets/6jpm-sxkc.