CMS extends RCD for an additional five years

The Review Choice Demonstration, which primarily involves a layer of pre-claim review for providers in six states, will continue for an additional five years, CMS announced Friday, May 17. The model was set to end at the end of May.

 

The demonstration will continue in Florida, Illinois, North Carolina, Ohio, Oklahoma and Texas.

 

Any providers who feel it is a hardship to continue participation in their current review choice selection and would like to modify their choice selection should notify Palmetto by June 14 to ensure their desired choice selection is updated.

 

As part of the extension, CMS is removing Choice 3: Minimal Review with 25% Payment Reduction from the initial choice selections. 

Medicare Administrative Contractor (MAC) Palmetto GBA will proactively reach out to coordinate with the small number of affected providers to make a new review choice selection.

 

Current Choice 3 providers must select between the other two initial review choice options: Pre-Claim Review or Postpayment Review according to the following dates:

 

 

Providers who do not make an initial review choice selection will default to participate in Choice 2: Postpayment Review. Providers with less than 10 reviews at the conclusion of the current cycle, will have their results included in the next cycle’s results.

 

All other Home Health providers in the demonstration states will continue in their current review cycles and follow their regular cycle timelines. For Oklahoma providers, the choice selection period for cycle 2 is July 1, 2024, through July 15, 2024. Cycle 2 will begin on August 1, 2024.

 

See the full announcment at https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-and-pre-claim-review-initiatives/review-choice-demonstration-home-health-services.