CMS Announces New ‘Phased-In Approach’ to the Review Choice Demonstration

The U.S. Centers for Medicare & Medicaid Services (CMS) announced Friday it will not resume a full-blown resumption of the Review Choice Demonstration (RCD) for home health agencies in participating states later this month.

Instead, CMS is “phasing in” RCD for agencies in North Carolina and Florida. Agencies in Illinois, Ohio and Texas will be granted flexibilities as well, according to CMS, which cited the current public health emergency as the reason for the newly announced RCD relief.

Despite ongoing operational challenges associated with the COVID-19 virus, CMS officials originally said in early July that the home health industry would once again be subject to RCD demands beginning Aug. 3. Broadly, RCD is a regulatory initiative meant to reduce improper billing by providers by requiring them to undergo pre-claim review, pre-payment review or post-payment review, among other options.

Advertisement

“Given the importance of review activities to CMS’s program integrity efforts, CMS will discontinue exercising enforcement discretion for [RCD] … regardless of the status of the public health emergency,” officials wrote in their July update.

Home health providers and advocates immediately pushed back on that announcement, arguing that CMS’s timing was “heartless” and “hypocritical.”

But over the past few weeks, industry stakeholders were able to meet with several key officials from the agency’s Office of the Administrator and Center for Program Integrity, Tim Rogers, president and CEO of the Association for Home & Hospice Care of North Carolina, told Home Health Care News in an email.

Ultimately, those stakeholders — a combination of providers, state associations, the National Association for Home Care & Hospice (NAHC) and the Partnership for Quality Home Healthcare (PQHH) — were able to get their point across, Rogers noted.

“We detailed every scenario we we could regarding hardships and RCD,” Rogers said. “[This is] a great example of when state associations and their members push hard on advocacy, with strong support from our national associations like NAHC and PQHH.”

Specifically, for North Carolina and Florida, agencies may submit pre-claim review requests for billing periods beginning Aug. 31.

Claims that go through pre-claim review and are submitted with a valid UTN will be excluded from further medical review. Claims submitted without going through the pre-claim review process will process as normal and will not be subject to a 25% payment reduction.

Moving forward, claims may be subject to post-payment review in the future through the normal medical review process, according to CMS.

On their end, providers who have already made a choice selection do not need to take any further action if they choose not to participate in RCD at this time.

CMS will reassess the “phased-in approach” in 60 days.

“Providers may choose to send in a handful of claims through the RCD platform to get their feet wet,” said Rogers, who also serves as chair for The Council of State Home Care & Hospice Associations and has a leadership role at the South Carolina Home Care & Hospice Association. “This will enable them to be confident and comfortable when RCD is required.”

Matt Wolfe, a partner at law firm Parker Poe, described CMS’s announcement as “an important” and “helpful” recognition of the need for home health providers to focus on quality clinical care and serving their communities during the COVID-19 spikes sweeping parts of the nation.

“The voluntary option also allows home health agencies to trial the pre-claim review process without putting their cash flow and operations fully at risk,” Wolfe told HHCN in an email. “I am hopeful that CMS will use this approach as a model moving forward for overseeing providers in a thoughtful and measured manner.”

While agencies in Illinois, Ohio and Texas aren’t afforded as many RCD flexibilities, they will likewise see some regulatory relief.

Cycle 2 in Illinois and Cycle 1 in Texas will end on Sept. 30. Affirmation and claim approval rates will be calculated based on review decisions made between Feb. 1 and Sept. 30 for Illinois providers, and between March 2 and Sept. 30 for Texas providers.

Cycle 2 in Ohio will begin on Aug. 31, as CMS previously noted.

Claims submitted under Choice 1 without going through the pre-claim review process will not be subject to a 25% payment reduction until further notice, but will be subject to pre-payment review.

“We consider this to be a victory,” Rogers said. “A very flexible situation for our providers, in fact, and a recognition of the serious nature of … this pandemic and the role home health caregivers are playing in the care continuum in North Carolina and Florida now, which was one of my stresses to CMS.”

Companies featured in this article:

, , , ,