A Review Choice Checklist

Palmetto GBA releases a Pre-Claim Review Initial Checklist to help home health agencies with documentation

What if you had a cheat sheet, a list of exactly what Medicare administrative contractor Palmetto GBA reviewers will look for as the new Review Choice Demonstration gets underway in Illinois beginning June 1?

Sound too good to be true?

Palmetto has released a tool it calls the Pre-Claim Review Initial Checklist to help home health providers make certain they have in place all required documentation. The checklist is available by clicking here.

“Hopefully this will prove to be a helpful tool to agencies concerned about what reviewers will be looking for,” said J’non Griffin, owner and president of Home Health Solutions.

The paperwork myth

One of the persistent myths about the Review Choice Demonstration is that it will entail new documentation or additional paperwork for agencies, she said, but reviewers will actually be checking to make certain claims meet all existing documentation requirements.

“There will be no new paperwork required,” J’non said. “Instead, reviewers will be making sure agencies have submitted all the documentation that is already required – and that the documentation submitted supports homebound eligibility and medical necessity.”

What happens if the documentation is not all there?

“Then the agency gets to try again,” J’non said. “There is no limit to the number of times home health providers will be able to submit claims for review prior to final claim submission.”

The Review Choice demonstration will be effective in Illinois for all episodes of care beginning on or after June 1. Only the Palmetto GBA jurisdiction will participate, and Illinois agencies not served by Palmetto will be exempt from the demonstration.

Providers have until May 16 to let Palmetto know which of three review options they will choose. The three options are pre-claim review for all claims, post-payment review for all claims or a third option which requires no pre-claim or post-payment review but reduces each payment to the home care provider by 25 percent overall. The third option does leave providers subject to some post-payment review in the form of Recovery Audit Contractor (RAC) review.

Some Illinois agencies qualify for two other options, involving less stringent post-payment review. Those agencies had affirmation rates of 90 percent or higher during the previous pre-claim demonstration which operated in Illinois in 2016-17.

The Centers for Medicare and Medicaid Services (CMS) has not issued a timeframe for when states other than Illinois will be added to the Review Choice demonstration, but has said that the next states will be Florida, Ohio, Texas and North Carolina. CMS has said those states will have at least a 60-day notice before they are required to join the demonstration.

We can help

Home Health Solutions has compiled a detailed list of 101 tips and strategies designed to pass reviewer scrutiny to help agencies shore up their documentation in preparation for Review Choice. This digital guide is presented in a quick-read, checklist format for busy professionals.

“Review Choice 101” is now on sale for $99 in The Solutions Shop, the online store on the Home Health Solutions web site.