The Review Choice Demonstration Program
The Review Choice Demonstration (RCD) program was established in 2017 in response to changes from stakeholder responses in the Home Health Services. The Centers for Medicare & Medicaid Services (CMS) paused the Pre-Claim Review Demonstration which was the program for the Home Health Services. The CMS announced its decision to implement the RCD review program for the Home Health Services via a PRA announcement and then deliberated on the comments and feedback from the public concerning the new program. The RCD program is involved in the collection of data and information about Home Health Services in all the states in America to include more flexibility and choices in the healthcare systems for care providers. The program also aims at giving the care providers more choices in the risk-based changes to lessen the burden on them by showing compliance with the Medicare home health guidelines.
The Review Choice Demonstration (RCD) program is meant to fight the improper home health care services billing. This improper billing in the home health Medicare totaled to about $3.2 billion in 2018 (Holly, 2019). The RCD will offer the healthcare providers in the home health organizations in several ways in which they can participate and benefit. The providers have the option of picking between pre-claim or post-payment evaluation methods with a minimum review choice that consists of a standard payment reduction of up to 25 percent. The home health organizations that have good and proven records or that have a proven record of about 90 percent will benefit from an option of choosing a post-payment evaluation option with less costly spot-check (Holly, 2019). The program will save money for the Medicare program and eliminate illegalities from dishonest care providers.
The Review Choice Demonstration (RCD) program officially started in the state of Illinois on June, 2019 with all the home health care agencies all prepared for the program. Many of the home health agencies in the state had already subscribed to the Pre-Claim Review Demonstration that was paused in 2016 and thus it will be easy for them to shift from the old program to the RCD program especially for those who chooses the pre-claim review (Easterling, 2019). However, the RCD program is a tedious process and will take more time regardless of the option the agencies chooses. It is estimated by now about 77 percent of the Illinois home health caregivers are working with the RCD program with almost all the agencies choosing the pre-claim review choice (Holly, 2019). There is not a single home health caregiver who has chosen the minimal review choice which comes with a review payment reduction so far since the program started. The program will then extend to other states such as the Ohio, Florida, North Carolina, and Texas.
By obtaining financial services from a company, the home healthcare agency owner will have good records that are very vital in the Review Choice Demonstration process. The home health care agencies will only need to notify the companies they have been getting financial services from the EMR records that the Review Choice Demonstration needs to carry out its review (Centers for Medicare and Medicaid Services, 2019). The agencies must coordinate with all their referral sources too to inform them of what the Review Choice Demonstration needs from them for a quick review process. The companies that provide services to these home healthcare agencies must provide accurate and timely records or documentation for a faster review. Therefore, it is necessary for every home healthcare agency to inform and educate any of the companies that have been providing them with financial and cost reports to understand what the Review Choice Demonstration needs for effective compliance with the Medicare’s home health billing process.
There are three options offered under RCD for Medicare claims review that is tasked to review the Home Healthcare Agencies billing records. The first option is the Pre-claim review. In this review option, the agencies will be required to request for temporary confirmation of coverage before offering the final assertions for payment (Benoit, 2018). Pre-Claim Review option assists the agencies to ensure that all the applicable coverage and coding necessities are fulfilled prior to final claim proposal (Centers for Medicare and Medicaid Services, 2019). The prepayment evaluation will get a 25 percent reimbursement discount in all billed claims. The second options offered under RCD for Medicare claims review is the Post payment Review. The agencies that will not subscribe to the Pre-Claim Review will automatically subscribe to the Post payment Review (Centers for Medicare and Medicaid Services, 2019). The review follows the usual evaluation claims process apart from the Medicare Administrative Contractors conduct appraisals for claims given for the duration of a six-month to validate compliance.
The third option is the Minimal Post payment Review which includes all the agencies that did not choose either the pre-claim or the post-payment review. In this option of review, however, a 25 percent reimbursement discount will be introduced to all billed submitted claims for the home health. The claims are also open to evaluation by the Recovery Audit Contractor (RAC). The home healthcare agencies will remain to be open to an evaluation method up until it reaches the set assertion or claims approval percentage (Centers for Medicare and Medicaid Services, 2019). When the set target verification or claim approval proportion is achieved, organizations can decide to be released of claim appraisals. However, a spot-checking which is an accessional review normally after every six months will remain to ensure continued compliance.
Documenting the need for skilled nursing care is important because it ensures that there is the delivery of safe, steady and quality healthcare for all the patients in the care facility. Documentation is the most important communication tool in a care facility where there are shift changes for the nurses who work in that place (Benoit, 2018). Documenting the care is important since it keeps records for the costs and other necessary records that can be used in the review of the facility performance and conducts. Health providers are required by law to keep records about their operation for easy auditing and billing review to ensure that all the ethics and guidelines concerning the taking of health care of the patients are followed.
In conclusion, the Review Choice Demonstration program is important since it will help expose home health agencies that have been operating in substandard levels and illegal activities in their provision of care. It will save the Medicare program money since it will expose t all the loopholes that the home health care providers use in the provision of substandard care. Through the use of the three option of reviewing process, the Review Choice Demonstration will ensure that all the agencies are evaluated and their records appraised to expose and rectify any misconducts in the home health care services. Therefore, it is important for any nursing agency to keep records or documentation since it facilitates communication among the nurses and also helps during government appraisals.
Benoit, F. (2018). Review choice demonstration for home health services. AXXESS. Retrieved from https://www.axxess.com/blog/news_n_update/review-choice-demonstration-home-health-services/.
Centers for Medicare and Medicaid Services (. (2019, Mar. 4). Review choice demonstration for home health services. Centers for Medicare and Medicaid Services. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Review-Choice-Demonstration-for-Home-Health-Services.html.
Easterling, K. ( 2019, May 7). Understanding the review choice demonstration. Home Care. Retrieved from https://www.homecaremag.com/may-2019/home-health-review-choice-demonstration.
Holly, R. (2019, May 20). How home health agencies can survive the review choice demonstration. Home Health Care . Retrieved from https://homehealthcarenews.com/2019/05/how-home-health-agencies-can-survive-the-review-choice-demonstration/.