{"id":644,"date":"2019-04-05T15:35:40","date_gmt":"2019-04-05T15:35:40","guid":{"rendered":"https:\/\/advantagehcconsulting.com\/blog\/?p=644"},"modified":"2019-04-05T15:35:41","modified_gmt":"2019-04-05T15:35:41","slug":"review-choice-demo-to-launch-june-1-in-illinois","status":"publish","type":"post","link":"https:\/\/advantagehcconsulting.com\/blog\/2019\/04\/05\/review-choice-demo-to-launch-june-1-in-illinois\/","title":{"rendered":"Review Choice Demo To Launch June 1 In Illinois"},"content":{"rendered":"\n
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Slowed cash flow poised to close more doors.<\/em><\/strong><\/p>\n\n\n\n

The other shoe is finally dropping for the Review Choice Demonstration \u2014 and it may smash home health agencies in RCD states.<\/p>\n\n\n\n

After initially announcing that it would begin RCD in Illinois in December, the Centers for Medicare & Medicaid Services <\/strong>has finally set a June 1 launch date for the medical review program that takes over from the halted Pre-Claim Review demonstration. CMS was able to nail down the implementation date because the Office of Management and Budget <\/strong>granted Paperwork Reduction Act approval for the program after a longer-than-expected wait.<\/p>\n\n\n\n

Ahead of the June 1 start date, home health agencies in Illinois will have from April 17 to May 16 to choose which of the program\u2019s three review options they want to use \u2014 pre-claim, postpayment, or \u201cminimal postpayment review with a 25% payment reduction.\u201d (See more details about each option in Eli\u2019s HCW, Vol. XXVII, No. 35.<\/em>)<\/p>\n\n\n\n

Advanced options: <\/strong>HHAs that achieve a 90 percent or higher \u201caffirmation\u201d rate after the first six months will get to choose from two further options \u2014 \u201cselective\u201d postpay review or \u201cspot check\u201d review. The former reviews \u201ca statistically valid random sample of claims\u201d while the latter reviews \u201ca random sample of 5 percent of a HHA\u2019s submitted claims,\u201d according to the RCD Operational Guide updated April 3. HHAs have to maintain their 90 percent affirmation rate to stay in those categories.<\/p>\n\n\n\n

Illinois agencies that achieved a 90 percent affirmation rate under the old PCR demo, which was halted in 2017, are in a unique position of being able to go straight to the advanced options. HHAs in the subsequent demo states of Florida, Texas, Ohio, and North Carolina won\u2019t have that choice.<\/p>\n\n\n\n

New, Small HHAs Hit Hardest<\/strong><\/p>\n\n\n\n

The long-delayed onset of RCD is \u201cbad news for HHAs,\u201d judges Sandy McCleve <\/strong>of Advantage<\/strong> Healthcare Consulting Cost Report & Reimbursement<\/strong>in North Salt Lake, Utah. The demo\u2019s intensive review will \u201cmean it will take a long time for agencies to receive payment for claims,\u201d having a negative effect on cash flow.<\/p>\n\n\n\n

\u201cIn an industry where cash flow is key, [RCD] is not a good thing,\u201d McCleve warns.<\/p>\n\n\n\n

\u201cNo matter which choice is selected, there will be cash flow slow-downs or reductions,\u201d cautions Joe Osentoski <\/strong>with Quality In Real Time <\/strong>in Troy, Michigan. \u201cI believe every Illinois agency will suffer some effect of RCD.\u201d<\/p>\n\n\n\n

But the impact will be particularly hard on \u201csmaller agencies and new agencies who may not have experienced the prior Pre-Claim Review Demonstration activity,\u201d Osentoski tells Eli<\/strong>. The same goes for HHAs that have \u201chad staff turnover since then, and so any prior experience is lost,\u201d he adds. \u201cThe value of prior PCRD experience is balanced by the re-learning curve of the RCD experience.\u201d<\/p>\n\n\n\n

Good news: <\/strong>One bright spot \u201cis that there\u2019s still a little time before it starts on June 1,\u201d highlights reimbursement expert M. Aaron Little <\/strong>with BKD<\/strong>in Springfield, Missouri.<\/p>\n\n\n\n

Note: CMS\u2019s RCD webpage, including a link to the Operational Guide, is at\u00a0www.cms.gov\/Research-Statistics-Data-and-Systems\/Monitoring-Programs\/Medicare-FFS-Compliance-Programs\/Review-Choice-Demonstration\/Review-Choice-Demonstration-for-Home-Health-Services.html<\/a><\/em>.<\/p>\n\n\n\n

Source- SuperCoder<\/a><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Slowed cash flow poised to close more doors. The other shoe is finally dropping for the Review Choice Demonstration \u2014 and it may smash home health agencies in RCD states. … Continue Reading →<\/a><\/p>\n","protected":false},"author":1,"featured_media":645,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[15,5],"tags":[34,23],"class_list":["post-644","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-home-health","category-reimbursement","tag-hha","tag-homehealth"],"_links":{"self":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/644","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/comments?post=644"}],"version-history":[{"count":1,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/644\/revisions"}],"predecessor-version":[{"id":646,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/posts\/644\/revisions\/646"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media\/645"}],"wp:attachment":[{"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/media?parent=644"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/categories?post=644"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advantagehcconsulting.com\/blog\/wp-json\/wp\/v2\/tags?post=644"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}