Home Health Review Choice Demonstration FAQ

August 5, 2021

In this article, we address frequently asked questions about what home health review choice demonstration is and how your agency can prepare.

 

Challenge Question 1

 

Q: Why is CMS conducting the Review Choice Demonstration?

 

A: To improve the incidence and reduce the amount of fraud and abuse in Medicare’s Home Health benefit

 

Challenge Question 2

 

Q: During the initial phase of the RCD, if the HHA does NOT choose options 1, 2, or 3 which option will they be automatically placed in?

 

A: Option 2, Post Payment Review 

 

Frequently Asked Questions 

 

Q: What placeholder on the UB04 will the UTN be added to?

 

A: You’re going to add that in the comment section so down in the form locator. I believe it’s form locator 80 that’s in the bottom left hand corner of your claim in the comments area. That’s where the UTN number will be added.

 

Q: Do we have to have a visit frequency at the start of care that reaches into the second period in order to ask for two billion episodes at the beginning?

 

A: Yes you will. You have to be able to prove that you have supporting documentation for the certification in order to submit those different periods of care into the PCR.

 

Q: What if you’re not affirmed can I attach other documents? 

 

A: Yes you can, and of course you can resubmit it. 

 

Q: When will the affirmation rate be looked at to determine 90%? What is the date/time frame of that?

 

A: 6 months from the time that you started the demonstration itself. So whatever state you happen to be in, they will look at six months from there. They then will affirm whether you’ve achieved 90% or better affirmation rate at that point. If you haven’t obtained it by the 6 month deadline, then you’re going to be asked to stay in phase 1.

 

Q: How do you control what patients show on the dashboard in KanTime?

 

A: You have some options. You can choose to start a care date to and from and then the same on the end date.

 

Q: What if you have received a fax for a face to face in KanTime?

 

A: You’ll still have to send it as part of the RCD packet. So anything that is received in KanTime can be downloaded as a PDF and included in your RCD transmission. 

 

Q: Do we have to ask for a connection between Ability and KanTime?

 

A: You just need to let us know that you’re using Ability and once you submit the request, we will bridge the gap. It’s already created and KanTime already has an integration with Ability. They are one of our preferred partners

 

Q: What if we receive the F2F in KanTime?  

 

A: When the agency is building their RCD submission file in KanTime, our System specifically looks for POC, OASIS, F2F, etc and the User then is able to choose the required and any additional documents they wish to include.

KanTime then builds and formats the document per the regulations for transmission.  When the UTN is received and populated to the file by the User, KanTime automatically puts it in the correct location in the claim.  If it is missing when the claim is generated it prompts for it.

 

Q: Does the current PDGM process allow for submission of the RAP for both Payment periods for a 60 day clinical period simultaneously?

 

A: Since each payment period requires its own UTN, this would then block the ability to submit both RAPs at the same time.

 

If you would like to learn more about home health Review Choice Demonstration, you can watch Ready or Not: RCD is Coming! or read “Key Takeaways from Ready or Not: RCD is Coming!”

 

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