Overland Park, Kan. (July 24, 2020) – Home health providers in Florida, Illinois, North Carolina, Ohio and Texas learned earlier this month that the Centers for Medicare & Medicare Services (CMS) would renew Review Choice Demonstration (RCD) beginning on August 3, despite CMS’ March 30 announcement that the RCD would be suspended “until the Public Health Emergency (PHE) for the COVID-19 pandemic has ended.” Days before the PHE was set to expire, the Department of Health and Human Services (HHS) announced it would also renew that declaration for an additional 90 days, as the law requires.
CMS developed the demonstration to reduce improper billing under Medicare’s home health benefit. During the RCD suspension, home health claims submitted on or after March 29 were not subject to the review choices made by home health agencies under the demonstration.
According to the CMS announcement, the initial choice selection period will begin in North Carolina and Florida on August 3 and end on August 17. The choice selection period for Ohio’s second review cycle will also begin August 3 and end on August 17. Following these choice selection periods, home health claims in all demonstration states with billing periods beginning on or after August 31, 2020, will be subject to review under the terms of the choice selected by the provider. This includes pre-claim review, prepayment review, post-payment review, or any applicable 25% payment reduction.
As of August 3, all pre-claim review claims that were sent without a Unique Tracking Number (UTN) during the suspension period for states that were already participating and agencies that chose the pre-claim option, will now have a post-pay review requiring documentation.
CMS has stated it will work with affected providers to develop a schedule for post-payment reviews that not does significantly increase provider burden. However, the agency received criticism from National Association for Home Care & Hospice (NAHC) President, William A. Doombi, who said, “The restart of the RCD program fails to take into account that we are at the height of the pandemic with no early end in sight,” Dombi said in a statement to Home Health Care News. NAHC has requested that CMS “step back from this action immediately.”
eSolutions, a partner to over two-thirds of the top 100 home health providers in the country, is ready to assist home health agencies no matter which RCD choice is selected. eSolutions’ Pre-Claim Review tool is designed to assist agencies who choose pre-claim review to affirm their claims and allows agencies to submit required files electronically through an easy-to-follow workflow. Providers can also track each claim through the process and receive notifications with status updates.
For providers who select post-payment review, eSolutions’ proven ADR tools electronically submit files and track each claim through the response process. These tools show providers the status of the response process and keep tabs on deadlines – allowing providers to prioritize workloads in an especially busy time.
eSolutions provides educational resources, including a comprehensive ebook, for providers interested in learning more and remaining successful amid the reinstatement of both the RCD and the ongoing public health emergency.