Author: Maxwell Healthcare Associates Posted: July 8, 2021
According to the Centers for Medicare & Medicaid Services (CMS), the review Choice Demonstration (RCD) assists 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. 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.
CMS has decided to extend the phased-in participation of the Review Choice Demonstration for Home Health agencies in Florida and North Carolina until 7/31/21. Here’s what it will entail:
Providers may continue submitting pre-claim review requests.
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. These claims may be subject to post payment review in the future through the normal medical review.