Review Choice: Who next and when?

Palmetto GBA fills in some of the blanks -- but leaves some big questions unanswered

Two of the biggest questions about Medicare’s new Review Choice demonstration remain unanswered after a Wednesday morning teleconference call hosted by Medicare administrative contractor Palmetto GBA.

When will Review Choice start in Illinois, and in what order will Texas, Florida, North Carolina and Ohio join the demonstration?

Palmetto’s outreach staff told home care providers during today’s call that there is no official word yet from the Centers for Medicare and Medicaid Services (CMS) on the start date, although the federal Office of Management and Budget gave final approval late last week.

“Palmetto is expecting word from CMS at any time now establishing the implementation date for Illinois,” said J’non Griffin, owner and president of Home Health Solutions.

“But CMS has not yet specified the order in which the demonstration will move into the other four other states selected to participate – or the timeline for how long it will take to move into the other states after it begins in Illinois.”

TPE rounds first

One piece of information related to the timeline was provided during the call. Palmetto officials said Review Choice will not be implemented at the same time home care providers 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.

Review Choice will be timed to begin in other states after any current TPE rounds have been completed, according to Palmetto officials.

Exact calendar date

CMS has not yet determined whether home care providers in Illinois will have two weeks, as previously discussed, 30 days or some other time period in which to review all options and choose one of at least three claim review processes.

“Providers were told they will be given specific information which includes an exact calendar date confirming how long they will have to make their decision,” J’non said.

All agencies will be given at least three options. They will be allowed to select either pre-claim or post- claim reviews – or opt out of the selection process and take a 25 percent penalty instead. Depending on their affirmation rates during the previous pre-claim review process in Illinois in 2016-17, some agencies are expected to be given additional claim review options.

Review Choice readiness

J’non recommends that 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.

(To read about the helpful services offered by Home Health Solutions, click here.)

F2F compliance help

Problems with the face-to-face encounter accounted for many of the non-affirmations experienced during the previous claim review demonstration in Illinois – and according to the most recent statistics from Palmetto, many agencies are still struggling to get F2F documentation right. F2F errors were responsible for almost one third of TPE denials in the final months of 2018, according to Palmetto.

Home Health Solutions offers some products that can help, including a helpful, 10-page F2F compliance guide priced at just $24.99.

Face-to-Face Encounter Documentation Tips $24.99

12 common F2F errors to avoid

“F2F: The Dirty Dozen” is a 10-page digital guide which highlights 12 of the most common documentation errors that can invalidate the F2F encounter. We cover the basics needed for F2F compliance, provide a helpful F2F Do and Don’t List, and even include a brief section on handling ADRs in the case of missed signature, dates, etc. Available as an instant download. No shipping costs or waiting. Check it out in The Solutions Shop, our online store.