Choice Review is Coming! Get Prepared with these FAQs

Choice Review is Coming! Get Prepared with these FAQs

How do I know when Choice Review will affect my agency? Since CMS is rolling out Choice Review with a series of demonstrations at different times in different states, the best way to know when your agency may be affected is by checking the CMS website. The CMS is generally providing 60 days advance notice.

Choice Review currently applies to home health agencies (HHAs) that operate in and render services to Medicare fee-for-service beneficiaries in Illinois, Ohio, North Carolina, Florida, and Texas AND that also submit claims to Palmetto GBA, Jurisdiction M MAC. If you provide services to beneficiaries in these states but do not bill claims to JM then the Choice Review demonstration does not apply to you.

What are the choices for HHAs under this new program?

There are currently three main initial choices as summarized below:

Choice 1:

  • Pre-claim review of all claims
  • Follows process implemented under the initial Pre-Claim Review Demonstration
  • Allows unlimited resubmissions of non-affirmed requests
  • Allows for multiple episodes to be requested on one pre-claim review request for a beneficiary

Choice 2:

  • Post-payment review of all claims
  • Follows current post-payment medical review processes
  • Default option if no selection made

Choice 3:

  • Minimal review with payment reduction
  • All home health claims receive a 25% payment reduction
  • Claims are excluded from MAC targeted probe and educate review, but may be selected for Recovery Audit Contractor (RAC) review

How long does my agency have to choose a review option?

Once the selection period begins in your state, your agency will have until two weeks prior to the start of the demonstration to select an initial review choice (pre-claim review, post-payment review, or minimal review with 25% reduction).

How do we choose a review option?

You can make your review choice selection through Palmetto GBA’s eServices online provider portal: http://www.palmettogba.com/eServices.

Are there any coverage changes associated with choice review?

Currently, we are not aware of any home health services coverage changes or additional documentation requirements.

Dominion Revenue Solutions is here to help HHAs handle claims under choice review. If your HHA needs assistance with billing or managing claims, let us know. An experienced, affordable and trusted partner to HHAs Dominion Revenue Solutions can help your agency with efficient billing services and by helping you maximize your revenue cycle. Learn more by contacting us at 888-471-9333.

Source: www.vgminsurance.com

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