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12/30/2019

Review Choice Demonstration: Guidance on Submitting Pre-Claim Review

The Centers for Medicare & Medicaid Services (CMS) recently released long-awaited guidance confirming that home health agencies (HHAs) will need to submit a pre-claim review (PCR) for each 30-day billing period. This guidance applies only to those home health agencies that are part of the Review Choice Demonstration and have selected the Pre-claim Review (PCR) option. 

CMS updated the RCD Operational Guide, Chapter 6, with the following:

For claims with dates of service of 1/1/2020 and after, HHAs will need to submit a PCR for each 30-day billing period. When requesting more than 30 days of services, the HHA can select the multiple episode/billing period option and submit two or more 30-day billing periods at the same time. In eServices, HHAs can select multiple episode(s)/billing periods once all tasks are completed for episode/billing period 1. For multiple episodes/billing periods, HHAs should enter the episode/billing period start and end dates, type of bill, HCPCS codes, and upload the POC, if changed, or refer back to the POC (Task 3) for episode/billing period 1. Each 30-day request will generate a separate UTN. When submitting the 30-day billing periods separately, all documentation for the episode must be submitted regardless if it is the first 30 days in the episode or the second 30 days in the episode.

Instead of an update to the RCD FAQs as expected, CMS updated the RCD Operational Guide. The update is dated December 5, 2019 but was not posted until very late on December 19.  

For questions about RCD and PDPM, please contact Anne Shelley at ashelley@leadingageohio.org.

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