Navigating the Review Choice Exhibition: A Home Health Guide to Pre-Claim Review Success
The Centers for Medicare & Medicaid Services (CMS) Review Choice Demonstration (RCD) initially sparked anxiety within the home health industry. Now, many providers are not only adapting but actively embracing the program, particularly the pre-claim review option. This article breaks down what you need to know to navigate RCD effectively, minimize revenue risk, and ensure compliance.
Understanding the RCD Landscape
The RCD, currently active in Illinois, Florida, Michigan, North Carolina, South Carolina, Texas, and now expanding, allows Medicare Administrative Contractors (MACs) to choose between pre-claim and post-claim review. The goal? To reduce improper payments and improve the quality of care.
Initially viewed as a potential “boogeyman” due to increased administrative burden, providers are realizing the strategic advantages of pre-claim review. Why the shift? Simply put,it’s about protecting your revenue.
Why Pre-Claim Review is Gaining Traction
The stakes are high. The home health industry is already facing proposed payment cuts. Post-claim review carries a notable risk of denied claims and subsequent revenue loss.
“If you did post-claim review… you’re at a higher risk of losing revenue,” explains LeGrand of LiveWell Partners, a multi-state home health and hospice provider. “Any chance that you have to prevent the possibility of lost revenue is huge, especially at smaller locations like we have.”
LiveWell Partners operates in states with varying RCD stringency, including Ohio. They’ve found that even states with stricter review processes can be managed effectively with the right strategies.
Key Strategies for RCD Compliance
So, how are successful agencies tackling RCD? Here’s a breakdown of best practices:
* Leverage Your EMR: Implement edits within your electronic Medical Record (EMR) to automatically flag Medicare claims requiring pre-claim review data. This proactive step minimizes errors and streamlines the process.
* Dedicated RCD Staff: Assign a dedicated team member to gather required documentation and upload it to the provider portal. This individual should be proficient in reviewing clinical notes, visit data, and assessments.
* Cross-Departmental collaboration: Don’t silo the RCD process. Success hinges on seamless communication between your orders team, clinical team, and revenue cycle team. Everyone needs to be aligned on documentation requirements from the start.
* Prioritize Accurate Documentation: Ensure all patient information is accurate,complete,and properly documented the first time. this minimizes revisions and speeds up the review process.A positive affirmation from the start is the goal.
The Impact of RCD: Is it Working?
According to Barnett,RCD is achieving its primary objective: reducing Medicare spending.
“there’s been a pretty decent trend of decrease in spending, though it’s slowed down over the years,” she notes. “When it was first implemented, there was a really deep decrease, and now it’s kind of leveled out, but still decreasing.”
However, the program isn’t without its limitations.
Addressing the Gaps in RCD Coverage
Currently, 12 states aren’t included in the RCD demonstration, limiting its national impact. Specifically, concerns are rising about billing practices in states like California, which fall under a diffrent MAC jurisdiction (National Government Services – NGS).
Implementing RCD in California would require CMS to engage NGS as an self-reliant contractor, a move considered unlikely at this time.This raises questions about whether RCD is truly addressing the most significant areas of improper billing within the home health landscape.
Looking Ahead: Maximizing RCD Success
While RCD has demonstrably decreased spending and perhaps simplified documentation for some providers, it may not be targeting the core issues within the home health program.
To maximize your success with RCD, focus on:
* proactive compliance: Don’t wait for audits. Implement robust internal review processes.
* Continuous Training: Keep your team updated on evolving RCD requirements.
* Data Analysis: Monitor your RCD submission rates and identify areas for advancement.
By embracing a proactive, collaborative approach, you can navigate the RCD landscape with confidence and protect your agency’s financial health.
Resources:
* [Home Health Care News: From Boogeyman To Buy-In](https://homehealthcare
