The Centers for Medicare & Medicaid Services has issued a second Paperwork Reduction Act (PRA) notice for public comment for the Home Health Pre-Claim Review Demonstration (A.K.A. Review Choice Demonstration). This notice is for a 30-day public comment period.
CMS proposes to initially implement the demonstration in Illinois, Ohio, North Carolina, Florida, and Texas with the option to expand to other states in the Palmetto/JM jurisdiction. CMS also proposes to begin the demonstration in Illinois on December 10, 2018.
Providers in the demonstration states may participate in either 100% pre-claim review or 100% post-payment review. These providers will continue to be subject to a review method until the HHA reaches the target affirmation or claim approval rate. Once a HHA reaches the target pre-claim review affirmation or post-payment review claim approval rate, it may choose to be relieved from claim reviews. CMS does not address what the target rate might be or how it will be calculated.
Providers also have the option of opting out of 100% pre or post-claim review by furnishing services and submitting a claim for an automatic 25% reduction in reimbursement and potential review by the Recovery Audit Contractor.