CMS to Extend Review Choice Demonstration by Five Years, to Remove One of Three Choices

McKnight’s Home Care | By Liza Berger

The Centers for Medicare & Medicaid Services will be extending the Review Choice Demonstration (RCD) for Home Health Services for an additional five years, effective June 1, CMS said on the Home Health, Hospice & DME Open Door Forum call on Wednesday. The demonstration will continue in the states of Illinois, Ohio, Texas, North Carolina, Florida and Oklahoma, an official said.

“This demonstration establishes the review choice process for home health services to assist in developing improved procedures to identify and prevent fraud, protect beneficiaries from harm, and safeguard taxpayer dollars to empower patients while minimizing unnecessary provider burden,” CMS said in a FAQ sheet about the model, which began on June 1, 2019. “The demonstration helps ensure that the right payments are made at the right time for home health service through either pre-claim or post-payment review, protects Medicare funding from improper payments, reduces the number of Medicare appeals, and improves provider compliance with Medicare program requirements.”

There have been three initial choices for agencies under the demonstration, which was slated to end on May 31. As part of the extension, CMS is removing Choice 3: Minimal Review with 25% Payment Reduction from the selections. Two remain: pre-claim review and post-payment review. Palmetto GBA, which administers Part A and Part B Medicare fee-for-service claims, will be reaching out to small numbers of affected providers to select from the two remaining choices, the CMS official said on the call. Selection will start on June 17 and remain open until July 1.

“Providers who do not make an initial review choice selection will default to participate in Choice 2: Postpayment Review,” CMS said on its website about the demonstration’s extension. “Providers with less than 10 reviews at the conclusion of the current cycle, will have their results included in the next cycle’s results.”

All other home health providers in the demonstration will continue in their current review cycles and follow their regular cycle timelines. Providers who believe their current review choice presents a “hardship” and would like to change their choice should notify Palmetto by June 14, CMS stated on the website.