Pending Office of Management & Budget approval, the Review Choice Demonstration is almost here. If your agency is in a targeted state*, have you picked your poison yet?
You can opt for Pre-Payment Review or Post-Payment Review. Or you can decide to forego 25% of your Medicare reimbursement and undergo a "soft" review. Three delicious flavors of poison.
Join Michael McGowan, Tim Rowan, Jim Plonsey, Cheryl Peltekis, and attorneys Liz Pearson and Lou Bernard on the 8th Annual Compliance Cruise. We will have lots to say about this and many other topics of interest to the home health and hospice communities.
We depart Ft. Lauderdale on Saturday, January 12 and return a week later. In between, we will have 3 intensive days of learning and informal consultations with the faculty, sprinkled with visits to the Bahamas, St. Thomas and St. Maarten, (where it is 84 degrees today).
* From the CMS Review Choice web page:
"Following the pause of the Pre-Claim Review Demonstration for Home Health Services on April 1, 2017, CMS worked to revise the Demonstration to offer more flexibility and choice for providers, as well as risk-based changes to reward providers who show compliance with Medicare home health policies. The proposed Review Choice Demonstration for Home Health Services will give providers in the demonstration states an initial choice of three options – pre-claim review, postpayment review, or minimal postpayment review with a 25% payment reduction for all home health services. A provider's compliance with Medicare billing, coding, and coverage requirements determines the provider's next steps under the Demonstration. CMS will implement the Demonstration for the Home Health and Hospice Medicare Administrative Contractor Jurisdiction M (Palmetto) providers operating in Illinois, Ohio, North Carolina, Florida, and Texas for five years, with the option to expand to other states in the Palmetto/JM Jurisdiction.
"The revised Demonstration will assist in developing improved methods to identify, investigate, and prosecute potential fraud in order to protect the Medicare Trust Funds, potentially reduce the rate of improper payments, and improve provider compliance with Medicare rules and requirements. Through either pre-claim or postpayment review, the Demonstration will help make sure that payments for home health services are appropriate."
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