Review Choice begins June 1

RCD selection process runs April 17-May 16 for home care providers in Illinois; no dates yet for other states

June 1 will be the launch date for the long-awaited Review Choice Demonstration in Illinois, the Centers for Medicare and Medicaid Services (CMS) announced this week.

But home care providers in Illinois will also need to mark May 16 on their calendars, as it will the final day to make RCD selections from several different options for either pre-claim or post-payment reviews. The selection process will begin April 17.

"Providers will be able to make their selections via a provider portal on the Palmetto GBA site, and specific instructions will be provided in letters that agencies should receive soon," said J'non Griffin, owner and president of Home Health Solutions.

If home care providers have not made a choice by May 16, they will automatically be subject to a post-payment review process for all claims, she added.

What about other states?

No timeline has been provided for expansion of Review Choice into Texas, Ohio, North Carolina and Florida, the four other states CMS has said it intends to include in the demonstration.

In an educational teleconference call in early March, CMS representatives said the demonstration would not expand to other states while they are undergoing Targeted Probe and Educate (TPE) as part of a CMS review strategy to identify common claims errors and provide one-on-one education. CMS said during the call that it plans to time the Review Choice demonstration to begin in other states after any current TPE rounds have been completed. More recently, CMS has since said it will provide at least 60 days advance notice to home health agencies in the other four states.

How it will work

Home health agencies in Illinois will be required to select either pre-payment claim reviews, post-payment claim reviews or a 25 percent overall reimbursement reduction with some limited post-payment spot checks. Agencies which had high affirmation rates during the previous pre-claim review demonstration in 2016-17 may be offered additional options by Palmetto.

All agencies with high affirmation rates will have additional options made available to them in December 2019, which will mark six months in the demonstration. (Read the CMS announcement about Review Choice in its entirety here.)

Review Choice readiness

J'non recommends agencies prepare for Review Choice by making certain their documentation is in order, with either in-house review processes to find and correct errors or outsourced services provided by a trusted partner with a proven track record. (Read about services offered by Home Health Solutions here.)

101 ways to pass reviewer scrutiny

The Home Health Solutions team is offering 101 tips to help agencies insulate themselves against reviewer scrutiny and boost affirmation rates in "Review Choice 101: A Primer for the Review Choice Demonstration."

The 32-page digital guide is available as an instant download in the Home Health Solutions online store at a sale price of $99. It's all in helpful, quick-to-read list format highlighting specific documentation strategies for establishing medical necessity, accurately documenting the face-to-face encounter, meeting all Start of Care requirements, complying with transfer and discharge summary requirements and more. Read more here.