Get Your Ten In: Florida and NC HHAs Should Submit Pre-Claim Review Requests

Published 02/04/2021

As the Review Choice Demonstration (RCD) for home health agencies (HHAs) in North Carolina and Florida continues, the end of Cycle 1 is approaching quickly. CMS has extended the phased-in participation in the RCD for HHAs in Florida and North Carolina until March 31, 2021. Providers do not need to take any further action if they choose not to participate. However, the phased-in participation does not change the cycle timeline for these providers.

Please take note of the RCD Life Cycle for providers in North Carolina and Florida:

North Carolina/Florida
End of Cycle 1
Begin Cycle 2 Selection
Last Day to Make Cycle 2 Selection
Cycle 2 Starts
Cycle 2 Ends

If the HHA’s full affirmation rate for Cycle 1 is 90 percent or greater (based on a minimum of 10 pre-claim review requests), the HHA may select one of the three subsequent review choices:

  • Choice 1: Pre-Claim Review (PCR);
  • Choice 4: Selective Postpayment Review; or
  • Choice 5: Spot Check Review

If the HHA’s affirmation rate is less than 90 percent, or they have not received decisions for at least 10 PCR requests, or they were in Choice 2 – 100 percent Postpayment Review during Cycle 1, the HHA must again choose from one of the initial three options.

For those providers wishing to have the opportunity to select from subsequent review choices (1, 4 or 5), the HHA full affirmation rate for PCR decisions in Cycle 1 must be 90 percent or greater (based on a minimum of 10 submitted pre-claim review requests or claims). All providers will be required to make a selection during the next selection cycle regardless of their Cycle 1 choice selection. If a selection is not made, the provider will be placed in the appropriate default Choice. The HHA will remain in that choice until the beginning of the next Cycle, as appropriate.

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