Home Health & Hospice Week

Florida, North Carolina agencies will start Aug. 31.

For home health agencies in Review Choice Demon­stration states, their pandemic-sparked reprieve is nearly at an end. And the same goes for all provider types for Medicare medical review overall.

“Given the importance of review activities to [the Centers for Medicare & Medicaid Services’] program integrity efforts, CMS will discontinue exercising enforcement discretion for the Review Choice Demonstration for Home Health Services, beginning on August 3, 2020, regardless of the status of the public health emergency,” CMS says in a July 7 post to its RCD webpage.

But the RCD engine won’t actually kick into full gear until Aug. 31. North Carolina and Florida agencies will undergo their “initial choice selection period” from Aug. 3 to Aug. 17. The choice selection period for Ohio’s second review cycle will also run those dates, CMS says.

“Following these choice selection periods, home health claims in all demonstration states (Illinois, Ohio, Texas, North Carolina, and Florida) with billing periods beginning on or after August 31, 2020 will be subject to review under the requirements of the choice selected,” CMS explains. “This includes pre-claim review, prepayment review, and postpayment review.”

Ongoing claims aren’t the only ones affected. “Following the resumption of the demonstration, the MAC will conduct postpayment review on claims subject to the demonstration that were submitted and paid during the pause,” CMS says.

That means for agencies that selected Option 1: Pre-Claim Review but didn’t submit PCR requests during the PHE, the bill is now coming due in the form of postpay review of all those claims.

Likewise, the small percentage of HHAs that chose Option 2: Postpay Review now will also have their claims reviewed.

In other words: As of Aug. 31, “everyone gets full RCD,” observes Joe Osentoski with Gateway Home Health Coding & Consulting in Madison Heights, Michigan.

Smaller impact: “Many Illinois providers opted to continue with PCR, so the effect of the resumption will be less in Illinois than in other states,” says Sara Ratcliffe of the Illinois HomeCare & Hospice Council.

Likewise, many Texas HHAs “elected to continue with RCD during the pause,” reports Pam Warmack with Clinic Connections in Ruston, Louisiana. They “developed a work flow that they chose not to interrupt.”

CMS is probably thinking since HHAs in Illinois, Ohio, and Texas are “basically meeting RCD requirements while under the PHE … why not move Florida and North Carolina onto it?” Osentoski theorizes.

The agencies that will see a heavy burden imposed overnight will be those in Florida and North Carolina, since they haven’t had to undergo the demo yet.

“What are they thinking?” exclaims Bobby Lolley of the Home Care Association of Florida. “Has CMS looked at the COVID statistics being generated here in Florida?” Lolley demands. “Providers here are fighting to save lives — patients, staff, and their businesses,” Lolley tells Eli. Resuming RCD is “beyond absurd … willful, and feels cruel and callous,” he says.

“This was a most unwelcome and disrespectful surprise at a time like this — a pandemic — when the health care systems in North Carolina and Florida are being stretched to the maximum,” says Tim Rogers of the Association for Home & Hospice Care of NC. “This is tone deaf at best.”

Further, North Carolina “hit a another record hospital­izations yesterday and our home health providers need to be focusing their time effort and energy on caregiving,” Rogers insists. HHAs are providing clinical support to hospitals and “are already taxed with workforce shortage, PPE, caring for COVID patients,” and more, Rogers says.

Bottom line: “You don’t kick someone when they are worn down from trying to help,” Lolley blasts.

“This announcement is a bit of a surprise,” National Association for Home Care & Hospice President William Dombi acknowledges. “CMS paused the expansion of RCD into Florida and North Carolina due to the stresses triggered by the pandemic. Those stresses continue today with the significant increase in COVID-19 infections, particularly in the affected states,” Dombi tells Eli.

CMS Goes Back On Its Word

M. Aaron Little with BKD in Springfield, Missouri, calls the announcement a shock. “We knew there would come a time when RCD would resume and North Carolina and Florida would be put back onto the calendar ... but I — and probably most others in the industry — assumed it would resume after the public health emergency was formally lifted,” Little says. After all, that’s “exactly what CMS stated” in the Frequently Asked Questions it issued when it made the RCD pause announcement in March, he points out (see Eli's HCW, Vol. XXIX, No. 12-13).

HHAs in the first three RCD states that did take advantage of the program pause are also facing a big burden. “All those backlogged [additional development requests] since late March are going to be issued as postpayment ADRs,” Osentoski observes.

Aside from the matter of perceived unfairness to HHAs, CMS is taking on a “tremendous workload” for RCD contractor Palmetto GBA with the resumption in such a short time frame, Little says. Florida and North Carolina have around 1,100 HHAs that will need to be brought on board, not to mention the portion of Texas’ roughly 2,100 HHAs that have opted out of the demo during the pause and will need to resume, Little notes.

This is a big task and is very concerning for agencies operating in areas within all these states still seeing surges in COVID-19 positive cases.

Stay tuned: CMS will post more information on the postpay review process in the “near future,” it says.

NAHC, HCAF, AHHC of NC, and others will be asking CMS for a reprieve, they say. “There’s no reason the RCD date can’t be pushed out until a more reasonable time to accommodate the challenges for the health care system in those states,” Rogers maintains.

Don't miss: The FAQs that accompany the RCD announcement also contain another “nugget,” Little highlights. When it comes to Targeted Probe & Educate (TPE) and other review from MACs, Supplemental Medical Review Contractors (SMRCs), and Recovery Audit Contractors (RACs). CMS also "expects to discontinue exercising enforcement discretion beginning on August 3, 2020, regardless of the status of the public health emergency,” the agency says in one FAQ.

“This is in direct opposition to the position previously stated by CMS in its March FAQs, since the PHE has not yet ended,” Little protests. CMS does allow that providers can, upon review, “discuss with their contractor any COVID- 19-related hardships they are experiencing that could affect audit response timeliness,” the FAQ says. But that is far from reassuring.

Note: The resumption announcement is at www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Review-Choice-Demonstration-for-Home-Health-Services.