CMS: Business as usual in August

Regardless of the public health emergency, home health will see medical reviews and RCD next month

While our nation debates the when, whether and how to re-open schools, sports and businesses, the Centers for Medicare and Medicaid Services (CMS) has made an important decision for home health:

It will be business as usual in August, regardless of the status of the public health emergency.

Beginning Aug. 3, CMS will resume medical reviews which have been suspended since March under discretionary enforcement due to the public health emergency, including Targeted Probe and Educate (TPE) reviews and post-payment reviews by Medicare administrative contractors, including Recovery Audit Contractors (RACs.)

On the same day, the initial review selection process will re-open for home care providers in Florida and North Carolina, and the second cycle review selection will re-open for providers in Ohio, in preparation for resuming the Review Choice Demonstration (RCD) in all RCD states on Aug. 31.

“The plan to resume RCD hasn’t exactly been welcome news in any of the RCD states, and particularly in Florida and Texas, where rising numbers of Covid-19 are being reported, ” said J’non Griffin, Owner and President of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care. "And the plan to resume medical review in all states on Aug. 3 including TPE and RACs, has caused dismay as well," she said. What CMS says CMS has changed the wording on its coronavirus FAQs for providers, reflecting the decision to resume reviews on Aug. 3. and offering advice to agencies who are worried about the impact of the public health emergency on the review process. "If selected for review, providers should discuss with their contractor any COVID-19-related hardships they are experiencing that could affect audit response timeliness," CMS states in the revised FAQs.

Home Health Solutions is prepared to help agencies with ADRs, including any reviews by Recovery Audit Contractors (RAC audits) and all post-payment reviews, J'non said. (For details, reach out via email here.)

Review Choice Home Health Solutions can also help agencies with RCD, J'non said. "We offer full RCD services. We can get agencies ready for RCD, and we can help agencies with their pre-claim submissions." Agencies in Florida and North Carolina will have until Aug. 17 to complete the selection process. Agencies in Ohio will participate in the second phase of their selection cycle during that same time frame. All billing periods beginning on or after Aug. 31 will be subject to RCD in the five states participating in the demonstration: Illinois, Ohio, Texas, Florida and North Carolina. Check out the store Did you know Home Health Solutions offers an online store with helpful products? We've just added a new QAPI-compliant Performance Improvement Project for $19.99 and will add PEPPER tutorials over the next couple of weeks. Take a look!