Need help with RCD?

Simione-HHS merger blends resources to help agencies meet Review Choice Demonstration requirements

Home care providers in Florida and North Carolina are nervously preparing to join Texas, Ohio and Illinois in Medicare's Review Choice Demonstration on Aug. 31, the date the Centers for Medicare and Medicaid Services (CMS) plans to resume the demonstration after a break during the Covid-19 public health emergency. In Ohio, the resumption of RCD marks the beginning of Cycle 2, meaning some providers who had high affirmation rates during the first six months of participation may have additional options for when their claims will be reviewed by the Medicare administrative contractor. As RCD resumes, providers in all five states will need to include a cover sheet with their electronically submitted medical documentation, according to an announcement this week by Medicare administrative contractor Palmetto GBA. Three pieces of demographic information must be included on each cover sheet: the Provider Transaction Access Number (PTAN), the National Provider Identifier (NPI), and the Contact Number. Home health agencies may also expect to see Additional Documentation Requests (ADRs) generated as the demonstration resumes, according to J'non Griffin, president of Home Health Solutions, a Simione Coding Company.

We can help

The good news for agencies, Griffin said, is that help is available for all aspects of the RCD process, whether the need is to set up processes for first-time participation in Florida and North Carolina, or in states where RCD is already underway, change processes to expedite workflow or respond to ADRs. This month's merger of Simione Healthcare Consultants and Home Health Solutions blends two teams of consulting expertise and resources to create a powerhouse of coding and consulting services to plug agencies into success, she said.

"Together, the expertise we offers home health agencies in Review Choice Demonstration states creates a firewall of protection against some common RCD problems," Griffin said. "We can help agencies prepare for RCD, make those pre-claim submissions, expedite their operational processes, respond to ADRs and more." Feeling overwhelmed?

RCD services available from Simione include reviewing operational processes from intake to billing, identifying holdups and opportunities to improve throughput. Simione can:

  • Implement processes to ensure the gathering of needed documentation

  • Monitor OASIS completion, coding and review processes and timing

  • Review medical records tracking and follow-up

  • Verify readiness through analysis of data and revenue cycle

  • Verify internal staffing and processes for efficient turnaround

Need help with pre-claim submission?

Simione will help agencies with the pre-claim submission, making certain all documents are are organized prior to clinical record submission.

Need a spot check?

If your agency is already undergoing RCD and has achieved a 90 percent affirmation rate, you may be thinking about choosing an option other than the full pre-claim review. Did you know Simione offers spot check reviews of documentation and processes to validate or identify areas of vulnerability?

Need help with ADRs? With the merger of Simione-HHS, the company has additional expertise available to help agencies handle ADRs and denials, including assisting with the appeal process, and reviewing and organizing documents prior to submission.

Need help talking to physicians? One of the challenges many agencies face under RCD is communicating to physicians the RCD requirements. Physician documentation plays a central role under both PDGM and RCD, but many agencies struggle to succinctly describe requirements to physicians. Our brochure template ($17.99 in The Solutions Shop) addresses the need for diagnosis specificity, lists the four questions physicians must answer in their documentation, and explains F2F requirements to physicians. Just print out copies as needed, fold the brochure and take it to the physician to help explain the process. Buy it here.

Call us at 800-949-0388 or contact us by email to learn more about how we can help you with RCD.