Update to Review Choice Demonstration from CMS

Sharon Hamilton MS, RN, CFDS
Clinical Consultant, Briggs Healthcare

If your HHA is in a state participating in the Review Choice Demonstration (RCD) and your agency selected the Pre-claim Review (PCR) option you will need to be aware of CMS’s update to the RCD Operational Guide, dated December 5, 2019. See excerpt below then follow the link to learn more.

“For claims with dates of service of 1/1/2020 and after, HHAs will need to submit a PCR for each 30- day billing period. When requesting more than 30 days of services, the HHA can select the multiple episode/billing period option and submit two or more 30-day billing periods at the same time. In eServices, HHAs can select multiple episode(s)/billing periods once all tasks are completed for episode/billing period 1. For multiple episodes/billing periods, HHAs should enter the episode/billing period start and end dates, type of bill, HCPCS codes, and upload the POC, if changed, or refer back to the POC (Task 3) for episode/billing period 1. Each 30-day request will generate a separate UTN.

When submitting the 30-day billing periods separately, all documentation for the episode must be submitted regardless if it is the first 30 days in the episode or the second 30 days in the episode.”

Click on the link: https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Choice-Demonstration/Downloads/RCD-Operational-Guide.pdf