Special Open Door Forum: Review Choice Demonstration for Home Health Services

Centers for Medicare & Medicaid Services Review Choice Demonstration for Home Health Services

Special Open Door Forum

Tuesday, November 27, 2018

1:30pm - 3:00pm Eastern Time

Conference Call Only

Please dial in 15 minutes prior to the start of the call

The Center for Program Integrity (CPI) will host a Special Open Door Forum (ODF) to invite home health agencies, physicians, and other Medicare practitioners to discuss the Review Choice Demonstration (RCD) for Home Health Services. 

As announced in the Federal Register Notice 83 FR 25012, as published on May 31, 2018, CMS has revised the previous Pre-claim Review Demonstration to offer more flexibility and choice for providers, as well as risk-based changes to reward providers who show compliance with Medicare home health policies.  The proposed Review Choice Demonstration for Home Health Services will give providers in the demonstration states an initial choice of three options – pre-claim review, post payment review, or minimal post payment review with a 25% payment reduction for all home health services. A provider’s compliance with Medicare billing, coding, and coverage requirements determines that provider’s next steps under the Demonstration.

CMS will implement the Demonstration for the Home Health and Hospice Medicare Administrative Contractor Jurisdiction M (Palmetto) providers operating in Illinois, Ohio, North Carolina, Florida, and Texas for five years, with the option to expand to other states in the Palmetto/JM Jurisdiction. CMS proposes to begin the demonstration on December 10, 2018, in Illinois. 

This revised demonstration would assist in developing improved procedures for the identification, investigation, and prosecution of potential Medicare fraud. The RCD would help make sure that payments for home health services are appropriate through either pre-claim or post payment review, thereby working towards the prevention and identification of potential fraud, waste, and abuse; the protection of Medicare Trust Funds from improper payments; and the reduction of Medicare appeals.

Here is the link to our Review Choice Demonstration page where slides will be posted in advance of this ODF: https://go.cms.gov/homehealthRCD.

You can find the 60-day Federal Register Notice here.

You can find the Paperwork Reduction Act (PRA) here.

Feedback and questions on to the Review Choice Demonstration for Home Health Services can be sent to: homehealthRCD@cms.hhs.gov.

We look forward to your participation.

Special Open Door Participation Instructions:

Participant Dial-In Number: 1-800-837-1935

Conference ID #: 2037247

Note: TTY Communications Relay Services are available for the Hearing Impaired. For TTY services dial 7-1-1 or 1-800-855-2880. A Relay Communications Assistant will help.

A transcript and audio recording of this Special ODF will be posted to the Podcast and Transcripts website at https://www.cms.gov/Outreach-and-Education/Outreach/OpenDoorForums/PodcastAndTranscripts.html for downloading.                

For automatic emails of Open Door Forum schedule updates (E-Mailing list subscriptions) and to view Frequently Asked Questions please visit our website at http://www.cms.gov/OpenDoorForums/.

Thank you for your interest in CMS Open Door Forums.