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HOME HEALTH: ARE YOU READY FOR RCD? YOU NEED TO BE!

The long awaited Home Health Review Choice Demonstration (RCD) is Set to Begin in Ohio on August 16, 2019!

By Beth Foster, RN, BA, CPHQ, CEHCH

Just yesterday CMS announced the choice selection period for Home Health Agencies (HHAs) located in Ohio will begin on August 16, 2019.

What You Should Know And Do NOW:

  1. HHAs MUST sign up to use the Palmetto GBA eServices provider portal now for information and instructions on the selection process. (HHAs can only make their selection through the eServices portal, and this is also the best way to submit the required documentation!)  If your HHA is already using the eServices portal, good for you!
  2. Through eServices, HHAs will be able to view their available choices and make their selection:
    1. Pre-claim review (PCR) – 100% review, least amount of paperwork, but need to obtain physician’s signatures timely, no limit to the number of times the PCR can be resubmitted; (This means you will eventually receive an affirmation!) or
    1. Post-payment review – 100% review, comparable to sending documentation for an Additional Documentation Request (ADR), most amount of paperwork; or
    1. Minimal post-payment review with a 25% payment reduction – most amount of paperwork, automatic 25% payment reduction on all payable claims
  3. Palmetto GBA will also send letters to all Ohio HHAs detailing this information.
  4. If HHAs that do not make a choice selection by the September 15, 2019, deadline, they will be automatically placed in Choice 2: Post Payment Review.
  5. Following the close of the choice selection period, the demonstration will begin in Ohio on September 30, 2019, and all episodes of care starting on or after this date will be subject to the requirements of the choice selected.
  6. As far as Targeted Probe & Educate (TPE), Palmetto GBA expects to complete all TPE rounds for Ohio providers prior to the start of RCD in our state.
  7. Please send any questions to: homehealthRCD@cms.hhs.gov
  8. More detail in Palmetto GBA RCD site.
  9. Listen to the Monthly RCD Provider Teleconference Schedule (August 7, 2019)
  10. Attend the OCHCH ANNUAL Fall Conference for RCD breakout sessions. Palmetto GBA staff will be presenting one of the sessions, “RCD Review with Palmetto.” 

I suggest that you look at the demonstration as a process improvement project. Hopefully in the long run you will increase the amount of reimbursement, and decrease the amount of money being taken back.

Beth Foster, RN, BA, CPHQ, CEHCH, is Director of Regulatory Affairs for the Ohio Council for Home Care and Hospice.  Her home care career began in 1989 as a visiting nurse, progressing into other positions including aide/intake coordinator, hospital system liaison, clinical care manager and director.  Previously she served as an Ohio Dept. of Health Surveyor for all provider types including Home Care & Hospice.