‘I’m Not Sure Their Timing Could Be Any Worse’: CMS to Resume Review Choice Demonstration

The U.S. Centers for Medicare & Medicare Services (CMS) announced Tuesday that the Review Choice Demonstration (RCD) would be renewed for participating states beginning in August.

The RCD was suspended in late March due to the COVID-19 crisis, but now CMS is planning on moving forward with the demonstration “regardless of the status of the public health emergency” beginning on Aug. 3.

RCD states include Illinois, Ohio, Texas, North Carolina and Florida.


“I’m not sure their timing could be any worse,” Linda Murphy, the founder and COO of Concierge Home Care in Florida, told Home Health Care News.  “This just heightens that challenge from a process perspective and adds additional administrative costs to all of the other unforeseen costs we’ve [taken on] to provide care.”

Concierge Home Care is a home health provider with six locations in northern Florida, which is now the world’s COVID-19 epicenter.

COVID-19 cases are sharply rising in Florida, with numbers increasing by over 400% from three weeks ago, according to NPR’s coronavirus tracker.


Originally, CMS suggested that the RCD would be suspended as long as a public health emergency was declared. And even if a declaration is no longer technically active in August, providers will still be on the front lines of a very active COVID-19 virus.

“It was a gut punch for providers,” Matt Wolfe, a partner at law firm Parker Poe, told HHCN. “[In many of these states], there’s significant increase in the number of COVID-19 cases and COVID-19-related hospitalizations, and our home health agencies are actively working with their hospital partners to help to relieve some of those challenges that those hospitals are facing.”

Now, those agencies are going to have to deal with increased and sudden administrative burden.

Through its continued relief efforts, Congress would appear to be at odds with this sort of “tone deaf” decision from CMS, Wolfe said.

“To be clear, it’s not just RCD — they’re now resuming all auditing activities,” Wolfe said. “They’re going in the opposite direction that Congress appears to have been instructing CMS to go. … We need to be utilizing government resources and provider resources on providing quality care to our Medicare beneficiaries, not on this paperwork exercise.”

According to CMS, the choice selection periods will begin in North Carolina, Florida and Ohio on Aug. 3.

Then, home health claims in all demonstration states with billing periods beginning on or after Aug. 31, 2020 will be subject to review, which includes pre-claim review, pre-payment review and post-payment review, among other options depending on compliance levels.

One of the only ways this sort of measure could be stopped would be through congressional intervention. Congress withholds the right to halt CMS from moving forward with RCD re-implementation.

Lawmakers successfully thwarted the expansion of the Pre-Claim Review Demonstration — the precursor to RCD — in 2017. As of now, it’s unclear how likely congressional action is this time around, however.

National Association for Home Care & Hospice (NAHC) President William A. Dombi also found the resumption of RCD misguided at this point in time. Dombi said NAHC — a Washington, D.C.-based industry association — has urged CMS to reconsider.

“The restart of the RCD program fails to take into account that we are at the height of the pandemic with no early end in sight,” Dombi said in a statement to HHCN. “Clinical staff need to be providing clinical services, not shuffling paperwork for a demonstration project. We have asked CMS to step back from this action immediately.”

It is clear that CMS is aiming to send a clear message to providers: public health emergency or not, it’s time to get your ducks in a row. CMS’s goal in RCD is to reduce improper billing under Medicare’s home health benefit.

But forcing providers to pay attention to the RCD may be drawing meaningful focus from elsewhere.

“It’s going to create some really challenging decisions for home health agencies that are already struggling to keep their doors open,” Wolfe said. “The experience in Illinois, [for instance], is that in order to be successful, you have to really deploy significant resources to ensure that all of your documentation is not just correct, but also submitted properly — it’s really time consuming and it drains resources.”

It could also be the case that CMS is going to be instructing Palmetto — the Medicare Administrative Contractor (MAC) that oversees Medicare benefits and claims under RCD — to perform post-payment reviews on all claims that were submitted during the delay period in Illinois, according to Wolfe.

It’s not clear whether that would be for Illinois or in all five states, though.

“I think CMS’s timeline is aggressive considering the state of emergency,” Murphy said. “We are seeing a spike in quarantined team members due to outside exposures. We are now mandated to test our team members every two weeks … We are [already] asking so much of our clinical teams to meet the challenges and demands.”

Total Medicare improper payments were estimated at $28.9 billion in 2019, according to CMS. Home health improper payments have steadily decreased dating back to 2015.

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