Home Health Review Choice Demonstration - The Basics

Published 05/01/2020

Following the pause of the Pre-Claim Review Demonstration for Home Health Services on April 1, 2017, the Centers for Medicare & Medicaid Services (CMS) worked to revise the demonstration to offer more flexibility and choice for providers, as well as risk-based changes to reward providers that show compliance with Medicare home health policies. 

The Review Choice Demonstration (RCD) for Home Health Services will give providers in the demonstration states an initial choice of three options:

  • Pre-Claim Review (PCR);
  • Postpayment Review; or 
  • Minimal Postpayment Review with a 25 percent payment reduction for all home health services

Note: 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 GBA) providers operating in:

  • Illinois (6/1/2019 implementation date) 
  • Ohio (9/30/2019 implementation date)
  • North Carolina (8/31/2020 implementation date)
  • Florida (8/31/2020 implementation date)
  • Texas (03/2/2020 implementation date)

CMS will monitor the transition to PDGM and assess the need for any changes to these dates.

The demonstration will span five years, with the option to expand to other states in the Palmetto GBA JM Jurisdiction.

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