Effective August 3, 2020, the Centers for Medicare & Medicaid (“CMS”) will resume Home Health Review Choice Demonstration (“RCD”) on home healthcare agencies located in Illinois, Ohio, Texas, North Carolina, and Florida. CMS originally suspended RCD for these states since March 31, 2020 due to the COVID-19 pandemic public health emergency. During the suspension, CMS’s contractor Palmetto GBA continued to review pre-claim review requests that agencies submitted, but paused post-payment reviews.
Background on RCD
RCD is a CMS compliance program to review claims submitted by home healthcare agencies for signs of fraud or abuse and use the review to improve and educate home health agencies on their compliance with Medicare program requirements.
Agencies initially participating in RCD are required to select whether claims should be subject to Palmetto GBA’s:
1. Pre-Claim Review that seeks provisional affirmation of claim coverage before the agency submits a final claim for payment;
2. Post-Payment Review of submitted claims; or
3. Minimal Post-Payment Review where all claims are subject to a 25% reduction in final payment.Every six months thereafter, agencies must again select how Palmetto GBA should review their claims.Agencies with less than 90% pre-claim review affirmation rate or post-payment review approval rate must choose among […]
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