Are You in a Review Choice Demonstration State? Prepare to Restart the RCD Process

Posted Monday, July 19, 2021 / Updated Thursday, August 5, 2021


The Review Choice Demonstration (RCD) is back in effect this summer for the home health agencies in the five states included in the demonstration project. At this point, it appears that the RCD will be limited to these five states – Ohio, Illinois, Texas, North Carolina and Florida. During the public health emergency, CMS suspended RCD submissions, however, they resumed this spring in Texas, Ohio and Illinois. CMS recently announced that full implementation will begin effective September 1, 2021, for Home Health providers in North Carolina and Florida. In preparation for full implementation, there will be an additional mid-cycle selection period between August 1, 2021 – August 15, 2021 for providers in these states. CMS also announced that all claims with dates of service on or after August 31, 2020, that are submitted on or after September 1, 2021, without a PCR decision on file will be pulled for pre-payment review. This means every agency will have to be at 100% submission by September 1, 2021. If not it could be dealing with tens, hundreds or thousands of ADRs. If you are a provider in NC or FL, we urge you to act now and contact your state association.

The intent of the RCD is to reduce improper billing by home health agencies by allowing them to submit claims under the review process of their choice. The RCD offers HHAs one of 5 choices for claims review: 1) pre-claim review, 2) postpayment review, 3) minimal review with 25% payment reduction, 4) selective postpayment review, 5) spot check review. HHAs must choose an option or will be assigned a default option 2 or 4. Those who select 3, will remain there for the duration of the demonstration. To be eligible to continue to choose among 1, 4 or 5, the HHA must have a 90% or better claim approval over six months based on a review of at least 10 claims.

For RCD-eligible home health agencies that seek assurance when submitting claims or have experienced a high rate of denials, participation in the prepayment review option of the RCD can provide some level of assurance. Claims that have passed a pre-claim review will be assigned a UTN and will be exempt from further medical review.

The pre-submission and prepayment review of claims guarantees payment of the claim for those that are approved. In exchange for a minimal review under choice 3, the HHA agrees to take a 25% reduction of the full reimbursement. HHAs that choose to submit claims normally will remain subject to postpayment review under the regular medical review process.

At Corridor, we have been helping agencies prepare their claims for preliminary review through the RCD. Several clients have attested to our high rate of pre-claim approval, the ease of working with our team and the high quality of our claims submitted for review. (For HHAs in the other 45 states, expect to be included in a Value Based Purchasing program slated to begin January 2022. More on that later.)

If you are in an RCD state, connect with Corridor to discuss whether the pre-claim review option is right for your organization. You’ll experience benefits such as:

  • An appreciation the value of RCD for your organization
  • The knowledge to build front-end processes that result in patient records that meet industry standards
  • Charts returned with affirmations

As the preferred RCD partner, Corridor has successfully helped HHAs achieve a 99% affirmation rate while under 100% pre-claim review resulting in the organization being able to switch to a 5% spot check.

If you are impacted by RCD, click here or call Corridor today at 1-866-263-3795.

About Corridor

For over 30 years, Corridor has partnered with home-based care providers, delivering powerful solutions to support the unique challenges of caring for patients in the home. Our team of operating executives, clinicians, and nationally renowned industry experts have run provider organizations and resolved the same challenges you face.

Focusing on key operational, regulatory and financial challenges, Corridor delivers solutions and deep expertise in codingclinical documentationcompliancebilling and education.

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