Home Health & Hospice Week

You can still skip the demo with no price to pay — for now.

Home health agencies in the Review Choice Demonstration states of North Carolina, Florida, and Ohio have until April 15 to submit their RCD choices for the next cycle. Or they can continue opting out altogether with no penalty — but missing out on a major protection.

Cycle 2 for North Carolina and Florida and Cycle 3 for Ohio will begin May 1, explains RCD contractor Palmetto GBA in new educational articles. HHAs that achieved a “full affirmation rate” of 90 percent or greater for the latest six-month period — Cycle 1 for the former two states, Cycle 2 for the latter — can pick less burdensome Selective Postpay or Spot Check review choices for the upcoming cycle if they wish.

Or: “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,” Palmetto confirms in the articles. The Centers for Medicare & Medicaid Services has extended its RCD phase-in for those states a few times now.

Lightening the claims review load by opting out of RCD may seem like an obvious no-brainer. But it comes with a risk: “Claims may be subject to postpayment review in the future through the normal medical review process,” Palmetto points out.

Claims that go through RCD pre-claim review and are submitted with a valid Unique Tracking Number (UTN) will be excluded from further medical review, explains the National Association for Home Care & Hospice in its member newsletter. That means agencies are given multiple chances to correct and resubmit a successful claim under the RCD PCR review choice, then are immune from medical review for that claim forever after.

The catch: That only goes for MAC review, however. “The HHA can still receive an ADR from our Comprehensive Error Rate Testing (CERT) contractor, the Recovery Audit Contractor (RAC) or the Unified Program Integrity Contractor (UPIC),” points out Palmetto GBA in its “Understanding ADRs When Participating in the RCD” article from earlier this year.

Take action: If you want to participate and earn MAC medical review exclusion, submit your choices by April 15, Palmetto instructs. If you choose not to participate, you “do not need to take any further action,” NAHC advises. v

Note: See detailed instructions for the different options in April 5 articles posted at www.palmettogba.com/palmetto/jmhhh.nsf/DID/B4HP2R8604 — scroll to the article list ranked by date at the bottom of the page.