03 Jan Review Choice Demonstration for Home Health Services
RCD Moves Forward in Texas and North Carolina
In the latest news for RCD, the choice selection period for Home Health Agencies (HHAs) located in Texas officially began on Jan 15th 2020, and will end on Feb 13th, 2020. HHAs can visit Palmetto GBA’s provider portal here for additional information and details on selection process. The portal guides HHAs through viewing their available choices and making selections. Any HHAs that do not make a choice selection by the February 13, 2020 deadline will be automatically placed in Choice 2: Post payment Review. After the conclusion of the choice selection period, the demonstration will begin in Texas on March 2, 2020, and all episodes of care starting on or after that date will be subject to requirements of the choice selected.
After the beginning of the demonstration in Texas, North Carolina and Florida on are set to begin on May 4, 2020. Additionally, CMS will phase-in Low Utilization Payment Adjustments (LUPAs) within the demonstration. The transition to the Patient-Driven Groupings Model (PDGM) will continue to be monitored by CMS with information available on their website.
How will PDGM affect RCD
Some of the most discussed questions in home health care discussions on and offline regarding how PDGM will impact RCD include the below questions and answers.
Question: For claims with dates of service of January 1, 2020 and after, if my claims are subject to PDGM billing policies, do I have to submit a PCR for each 30-day billing period and if so what documentation is needed?
Answer: Each 30-day billing period will need a PCR and may be submitted as an initial PCR request. For providers asking for more than 30 days of services, the provider can select the multiple episode/billing period option and submit 2 or more 30-day billing periods simultaneously.
Question: Once PDGM starts, is the same UTN required on both 30-day period claims?
Answer: No. If the multiple episode/billing period option is utilized, 2 or more UTNs will be generated; one for each 30-day period. Providers will need to put the correct UTN on the corresponding 30-day billing period claim to ensure avoidance of an RTP.
Question: Is there a chance that the first 30-day billing period in an episode be affirmed, and then the second one could be non-affirmed?
Answer: Not likely. Generally, Home Health episodes of care are for a sixty day period. So long as all requirements are met for an entire episode of care, the second 30-day billing period will also be affirmed. If a plan of care in question only covers the first thirty days of the episode, the second thirty day billing period within the sixty day episode would be non-affirmed.
Question: Upon submission of a single PCR for the first 30-day billing period, followed by a later submission of a request for the second 30-day billing period during the same 60-day certification period, is it necessary to upload all of the documentation a second time?
Answer: Yes, it would be required to upload new documentation. It is suggested that providers use the multiple episode/billing period feature to avoid the inconvenience of having to submit the same information multiple times.
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