As deadline nears, Texas home providers opting for pre-claim review
Three days away from a deadline to choose the type of Medicare claim review process they want to undergo, most home providers in Texas appear to want claims reviewed prior to submission rather than after. Medicare administrative contractor Palmetto GBA is reporting on its web site as of today that 93 percent of the Texas home care providers who have already made a decision have opted to undergo pre-claim reviews when the Review Choice Demonstration begins there March 2. But as of last week, around half of Texas agencies still had not let Palmetto know what their decision would be. "Thursday, Feb. 13, is the deadline for Texas to decide," said Home Health Solutions Owner J'non Griffin. "So any agencies which have not made a decision will need to do so by then -- or they will be signed up by default under the post-payment review option. That means 100 percent of their claims will be reviewed after the final claim process." So far, the numbers in Texas are looking similar to those in Ohio and Illinois, the two states which are already operating under RCD, where the majority of providers opted for pre-claim review. Texas joins the demonstration March 2. Florida and North Carolina will join May 4. New way to keep up Home care providers in RCD states now have a new way to keep up with important Review Choice information pertaining to their agencies. Palmetto has just added a new feature to the provider dashboard in the secure e-Services area of its web site. "This will offer agencies a way to keep up with their RCD affirmations or claim approval rate, as well as their current Additional Documentation Request (ADR) and Pre-Claim Review (PCR) decisions," J'non said. The information will be located in e-Services account under the e-Review tab on the provider dashboard. Palmetto has said it plans to update the information weekly to keep providers updated. What's next?
As RCD moves forward, there is some unease within the home health field about plans to include Low Utilization Payment Adjustments (LUPAs) within the demonstration. CMS has said it will phase in LUPAs, which were previously excluded. The Patient-Driven Groupings Model brought about a major overhaul of LUPAs for home care providers, changing thresholds across the spectrum to set varying amounts. CMS has said it is monitoring the transition.
Shore up your documentation Making certain documentation meets the criteria for both medical necessity and homebound status has never been more important for agencies, according to J'non. Palmetto recommends that agencies be able to answer the four specific questions pictured below about each patient in order to pass reviewer scrutiny.
Our workbook shows you how.
Home Health Solutions addresses each of these four questions in detail in our RCD Staff Training Workbook, a helpful guide divided into four sections for four easy staff training sessions. Each section provides review questions and features Q&As from agencies. The Workbook is sold for $59.99 in our online store -- and your agency will only need one for all staff, as it is designed to be copied. It's available as an instant download in PDF format. Take a closer look here. And, especially for therapy ...
With therapy in the hot seat, our digital handbook for therapists is another great aid. This 16-page guide is a quick read, designed to be read in one sitting and reviewed during staff training sessions. It's packed with valuable information such as the 12 necessary components for an initial assessment, the six pieces of a treatment plan, details often left out of the assessment and how specific wording can make the difference between skilled or unskilled service. The handbook is available as an instant download in PDF format, and you'll only need one for your staff. Take a closer look here.