Is Illinois ready for Review Choice?

Summer is showtime for home care providers in Illinois. Will Review Choice fizzle again?

Fireworks, poolside barbecues and outdoor activities marked the beginning of summer over the long Memorial Day holiday, but for home health, an explosive question looms just beyond the holiday as May fades into June.

Will the new Review Choice Demonstration launching June 1 in Illinois be a picnic for home care providers because of lessons learned during the Pre-Claim Review (PCR) Demonstration two years ago – or will the new demonstration fizzle and misfire as badly as the previous one?

“Illinois providers have everyone’s full attention this summer,” said J’non Griffin, owner and president of Home Health Solutions LLC. "Home care providers in Illinois are somewhat better prepared this time around, armed with prior experience and coaching which could make a real difference, but no one can say for sure how the demonstration will unfold this summer until it actually gets underway."

The PCR demonstration in 2016-17 shut down an estimated 50 home care providers in Illinois who were unable to meet the demonstration demands. Although the Centers for Medicare and Medicaid Services (CMS) will not require any new paperwork for pre-claim submission, the demonstration does require specific documentation in place to establish homebound eligibility and medical necessity, and evidence must be provided that the face-to-face encounter between physician and patient met all requirements.

“Review Choice is all about having all the necessary documentation in order,” J’non said.

The PDGM question

There’s another worrisome question at play as Review Choice moves forward in Illinois – and it could make what happens during the second six months of the demonstration more important than what happens this summer and fall.

Medicare’s new payment model, the Patient-Driven Groupings Model (PDGM) will impose shorter, 30-day billing cycles on home care providers when it takes effect Jan. 1, 2020.

“It remains to be seen how that will play out in Illinois, where the Review Choice demonstration will be going on at the same time,” J’non said. “And we don’t yet know whether Illinois will be the only state under the demonstration, because CMS has not given us that timeframe.”

Additional states could be included in the demonstration by the time PDGM becomes effective. CMS has indicated that Florida, Texas, Ohio and North Carolina will be included in the Review Choice demonstration next but has not provided the schedule for when those states will join the demonstration.

CMS has said that it will provide a 60-day notice before the demonstration launches in any additional states beyond Illinois.

We can help

The Review Choice 101 Digital Guide from Home Health Solutions includes 101 documentation tips and strategies to pass reviewer scrutiny – all presented in checklist form to save time for busy home health professionals.