Home Health & Hospice Week

HHAs already under RCD also get a breather with lifting of 25% payment penalty.

The Centers for Medicare & Medicaid Services “is phasing in participation in the Review Choice Demonstration for Home Health Agencies (HHAs) in North Carolina and Florida, for a limited period of time, to help ease the transition during the current public health emergency,” the agency says in an Aug. 21 post to its website.

Reminder: CMS announced RCD would resume with claims beginning Aug. 31 both in states that already were operating under the demo (Illinois, Ohio, and Texas) and states newly beginning the program.

Agencies in North Carolina and Florida can begin submitting pre-claim review requests for billing periods beginning Aug. 31, but they don’t have to. “Claims submitted without going through the pre-claim review process will process as normal and will not be subject to a 25 percent payment reduction,” CMS says.

However, such claims “may be subject to postpayment review in the future through the normal medical review process,” CMS points out. In contrast, when claims “go through pre-claim review and are submitted with a valid UTN,” they “will be excluded from further medical review,” the agency confirms.

Just how long the phase-in will last is unclear. “CMS will reassess the phased-in approach in 60 days,” it says on the RCD webpage.

HHAs in Illinois, Ohio, and Texas also can get a breather, but it’s a little different. “Claims submitted under Choice 1 without going through the pre-claim review process will not be subject to a 25 percent payment reduction until further notice, but will be subject to prepayment review,” CMS says of those states.

Also: “Cycle 2 in Illinois and Cycle 1 in Texas will end on September 30, 2020” — the month-delayed date CMS recently designated (see Eli’s HCW, Vol. XXIX, No. 31). “Cycle 2 in Ohio will begin on August 31, 2020, as previously noted,” CMS says.

Some Relief Is Better Than None

The phase-in announcement comes after HHAs in Florida and North Carolina lobbied zealously for a break, and it may not totally satisfy providers.

“We would rather have had a full delay until the state of emergency was ended,” says Bobby Lolley with the Home Care Association of Florida. “The homecare sector here in Florida still faces significant challenges," Lolley says.

But a small concession is better than no concession. “We are thankful for the … gentler start, which we hope will help ‘flatten’ out our members’ RCD learning curve,” Lolley tells Eli.

Meanwhile, Ohio HHAs are “really excited to get this news,” says Joe Russell with the Ohio Council for Home Care & Hospice.

Then: “Under the normal regulation, if providers are in the [pre-claim review] option but don’t submit PCR with a valid UTN, they receive the 25 percent reduction and they have 100 percent of their claims reviewed prior to payment” via an ADR,” Russell explains. “Many providers see this as a double penalty and think that getting the ADR plus the 25 percent reduction is somewhat unfair.” That double penalty “perhaps negated the usefulness of PCR” in some agencies’ opinions, he suggests.

Now: “With this flexibility, providers that submit PCR without a valid UTN will still get an ADR, but not have the penalty on top of that,” Russell highlights. “Our members are satisfied that at this time there is not a 25 percent reduction, and are OK with the 100 percent prepayment review of their claims.”

“Any change that eliminates a 25 percent payment reduction — even subject to pre- or post-pay medical review — is a good change,” agrees reimbursement expert M. Aaron Little with BKD in Springfield, Missouri. “At this point, any kind of phase-in or flexibility is welcomed and appreciated by providers,” Little observes.

Ohio agencies would “like to see [this] go in as a permanent change,” Russell adds.