Review Choice Demonstration (RCD)

From dated 9/1/2023: CMS will be implementing the Review Choice Demonstration (RCD) for Home Health Services in Oklahoma, effective December 1, 2023. CMS has the ability to expand the demonstration to additional states in the JM MAC jurisdiction if there is evidence of fraud, waste, or abuse in those states. Claims analysis showed increased utilization of home health services in Oklahoma, and Oklahoma had higher allowed expenditures and utilization of home health services than the remaining states in the Home Health & Hospice Medicare Administrative Contractor (MAC) Jurisdiction M not already included in the demonstration. To ensure compliance with Medicare home health requirements and protection of the Medicare trust funds.

To Summarize:  RCD is Medicare asking you how you want them to review your claim data and charting documentation.  Do you want to submit on the front end or the back end?  If you don’t want Medicare to review your claims and documentation, you can take a 25% reduction in reimbursements.  The initial selection choices are listed below:

Pre-Claim Review (PCR)

  • All Billing Periods are subject to Pre-Claim Review.
  • Unlimited Resubmissions are allowed for non-affirmed decision prior to submission of the final claim for payment.
  • More than one billing period of care may be requested on one Pre-Claim review request for a beneficiary.
  • Claims associated with a provisionally affirmed request will not undergo further medical review, except in limited circumstances.

Post-Payment Review

  • 100% of claims are reviewed after final claim submission.  This will be the default selection if provider makes no selection by 11/15/2023.
  • Once the claim is submitted, Palmetto will process the claim for payment then an ADR will be issued for the agency to submit medical records.  If a response to the ADR is not received, an overpayment notification will be issued. 

Minimal Review

  • 100% of claims have a 25% payment reduction.  Providers who make this selection will be excluded from regular MAC targeted probe and educate reviews but may be subject to potential Recovery Audit Contractor (RAC) review.
  • Providers who select this option will remain in this option for duration of the demonstration.

If you are unsure how to navigate the RCD waters, we can help! Being a Texas based billing company, Majestic Billing Services LLC has years of expereince in dealing with the Review Choice Demonstration (RCD) and can help your agency determine the optimum selection choice! We can also show you how RCD can actually benefit your company! Call us today at 469-406-5661 or book your free consultation below!