If your agency has been delaying operational and process updates needed for the Review Choice Demonstration (RCD), it looks like time is almost up. CMS announced last week that RCD is coming back “regardless of the state of the public health emergency”. CMS feels they must reinstate their program integrity efforts. Most agencies see this as increasing burdens and another roadblock to caring for patients. Unfortunately, due to their previous experience, CMS believes there are compliance and integrity issues costing them money.
CMS is also bringing in the last 2 states in the demonstration to complete the phase-in of all the states involved. It will roll out as follows
- August 3-17, 2020 - Initial choice selection for North Carolina and Florida and the second review cycle choice for Ohio
(For a review of the options for RCD with guidance please refer to our blog post -REVIEW CHOICE DEMONSTRATION here)
- August 31, 2020- Claims with billing periods starting on or after August 31, 2020 in all demonstration states -Illinois, Ohio, Texas, North Carolina, and Florida will be subject to review under the terms selected by the provider.
- After August 31, 2020- The MAC will start conducting post payment review on claims subject to the demonstration that were submitted and paid during the pause. CMS will develop a schedule that is to be announced which they promise will not significantly increase provider burden.
- If your agency continued with Pre-Claim Review (PCR) during the pause and were affirmed and given a unique tracking number (UTN) those claims will continue to be excluded from “most” future medical review.
To read CMS full information on the RETURN OF REVIEW CHOICE click here
Need more information on RCD and PDGM? OperaCare has multiple blog posts which address regulations and timelines along with operational and process driven information to help your agency make the change. Check out these previous posts full of information below
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OperaCare's combination of consulting and data driven quality assurance is bringing peace of mind to our users. The Operacare system empowers your agency to thrive in PDGM, RCD and any value-based model of care.
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