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Illinois Home Health Agencies to Begin Review Choice Demonstration Cycle 3 and Texas Home Health Agencies to Begin Review Choice Demonstration Cycle 4

Tiffany Karlin

October 01, 2020

The CMS is phasing in participation in the Review Choice Demonstration for Home Health Agencies (HHAs) in North Carolina and Florida, for a limited period, to help ease the transition during the current public health emergency.

Specifically, for HHAs in North Carolina and Florida, providers may submit pre-claim review requests for billing periods beginning 8/31/20. Claims that go through pre-claim review and are submitted with a valid UTN will be excluded from the further medical review. Claims submitted without going through the pre-claim review process will process as normal and will not be subject to a 25% payment reduction. Claims may be subject to post-payment review in the future through the normal medical review process.

Providers who have already made a choice selection do not need to take any further action if they choose not to participate. CMS will reassess the phased-in approach in 60 days.

For providers in Illinois, Cycle 2 will end on September 30, 2020. For providers in Texas, Cycle 3 will end on September 30, 2020.  Affirmation and claim approval rates will be calculated based on review decisions made between February 1, 2020, and September 30, 2020, for Illinois providers and between March 2, 2020, and September 30, 2020, for Texas providers.

Cycle 2 in Ohio began on August 31, 2020. Claims submitted under Choice 1 without going through the pre-claim review process will not be subject to a 25% payment reduction until further notice but will be subject to prepayment review.

 If an agency reaches a target approval rate after six months through the pre-claim review or post-payment review, they will have additional choices, including relief from most reviews except for spot checks to ensure continued compliance.

HHAs can visit the Palmetto GBA provider portal for information and instructions on the selection process. Through the portal, HHAs can view their available choices and make their selection during their choice selection period.

Contact our Healthcare team for tips on preparing for RCD. Looking to simplify your Medicare billing contact the Mueller Prost Healthcare Team for more information on our back-office solutions for Health Care Providers.

Texas Providers

Illinois Providers

RCD KEY DATES

June 2019: RCD launched in Illinois

September 2019: RCD began in Ohio

March 2020: RCD launched in Texas

August 21, 2020: CMS announced it is phasing in RCD participation for HHAs in North Carolina and Florida, for a limited time to help ease the transition during COVID-19

August 31, 2020: Cycle 2 began in Ohio

September 30, 2020:Cycle 1 in Texas and Cycle 2 in Illinois will end

December 01, 2020: Cycle 2 in Texas and Cycle 3 in Illinois will begin  

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