Most agencies will want prepay review.
The Review Choice Demonstration will be here in less than two months. Here’s what smart home health agencies will be prioritizing between now and then.
1. Stay tuned for every detail. Specifics are still emerging about the program, notes Joe Osentoski with Quality In Real Time in Troy, Michigan. In an April 3 RCD teleconference, HHH Medicare Administrative Contractor Palmetto GBA told attendees there would be a raft of teleconferences, webinars, and other educational events and materials taking place and being posted in the runup to RCD. “Track them down, put them on a schedule so all are attended, and use as many as possible to stay current with all aspects of restarting and then implementation as of June 1 for Illinois,” Osentoski advises. HHAs in the other four demo states should consider hopping on these calls as well, he adds.
2. Disseminate the information. It’s not just management who needs to know about the new program. When you learn about RCD, make sure others who need to know are clued in as well. “Ensure that the information is shared among agency planning staff,” Osentoski urges.
3. Decide which option is for you. “HHAs should take immediate action to opt for the pre-claim review rather than just waiting and being forced into postpayment review,” counsels Sandy McCleve of Advantage Healthcare Consulting Cost Report & Reimbursement in North Salt Lake, Utah.
The “vast majority” of agencies should opt for Choice 1: Pre-claim Review, Osentoski agrees.
But just because it works for most, doesn’t mean it’s right for all, cautions reimbursement expert M. Aaron Little with BKD in Springfield, Missouri. “Illinois agencies need to closely review the various options available to them and be thoughtful about their RCD selection,” Little tells Eli. “There are operational and payment implications to either pre- or postpay review that every agency needs to really consider,” he advises.
4. Sign up to sign up. “Providers will only be able to make their choice selection through [Palmetto’s] eServices portal,” the MAC emphasizes on its website. “We want to encourage all providers to sign up or verify your username and password.”
The consequences for not doing so are serious. “Providers that do not make a selection prior to the selection period will be placed into a qualifying default option,” i.e., Selection 2, Palmetto emphasizes (see related story, p. 98). And if you can’t sign into the system, you can’t make your selection.
5. Hit the deadline. Do not stall on signing up for eServices or choosing your option. “Do not be late on that,” Osentoski stresses.
6. Start mapping out training. “The ‘how to’ submit a pre-claim is perhaps the most important task to know for the RCD process,” Osentoski judges. Your billing staff are going to need to know the ins and outs of the procedure before RCD begins. And your clinical staff who will collect and oversee the clinical documentation will need to learn how to do so quickly, efficiently, and accurately.