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Home health agencies have had to evolve to accommodate the Review Choice Demonstration (RCD), in particular, Pre-Claim Review. Likewise, an evolution of sorts has occurred in the interpretations and practices of the medical reviewers. We will examine the recent trends that have emerged, review some examples and learn how to ensure that the documentation your agency is submitting will affirm quickly, now and in the future.    Speakers/Course Authors - Kimberly Wilkerson, MBA, LPN, CHCE, COS-C, HCS-D  Read More

Some agencies are in first round selections, some are in second round selections, and some agencies are unsure of where to go from here. In this preconference session we will have a panel discussion on the things we have seen with submissions on PCR, how to decide which is the best level to choose on 2nd choice. Bring your questions to this informative session! Speakers/Course Authors - J'non Griffin, Kathy Harrison & Kim Wilkerson Read More

While the goal of submitting claims in the Review Choice Demonstration (RCD) project is to obtain provisional affirmation or payment, not all claims may end up achieving this status.  At that time the home health agency is faced with a choice of what to do with the claim: write it off as non-billable or appeal and seek payment. Even with the unlimited ability for resubmission under Pre-Claim Review (Choice 1), some claims will not achieve a provisional affirmation status. If the home health agency feels strongly for coverage, submitting the claim for final billing will generate an automatic denial. And for the Additional Development Request (ADR) prepayment (Choices 2, 5) and postpayment (Choice 4) options, an unfavorable decision only gives one option to obtain payment: appeal the denial. This presentation provides an overview of the RCD choices, agency options for a non-affirmed or denied claim, and preventive measures that minimize chances of an unfavorable RCD claim submission. This uses common denial reasons (applicable to the ADR choices) and non-affirmation reasons (for pre-claim reviews) and addresses how to prevent these for a smoother RCD experience. The process for filing appeals is also covered. Some areas covered include physician face-to-face (F2F) issues, certification deficiencies, and the most common medical necessity denials, including therapy documentation.   A thorough walk-through of F2F encounter requirements and how the F2F content links with PDGM payment and possible denials or non-affirmations is covered.  How these are applied to appeals for denied claims is presented.   Speakers/Course Authors - Joe Osentoski  Read More

Get your Medicare Review Choice Demonstration (RCD) questions answered! Join HCAF and Healthcare Provider Solutions' Melinda Gaboury for a deep dive into the RCD process.  Course Author: Melinda A. Gaboury, COS-C  Read More

The most up-to-date information on the ongoing Review Choice Demonstration and managing a plan of care for your outpatients that is effective and compliant.   Course Instructor:  Elizabeth Brogdon, Swandra Miller & Cara Mia Wilkins Read More

We can try to pretend it isn’t going to happen but, like it or not, Medicare’s Review Choice Demonstration (RCD) is coming soon! The phased-in approach has already begun and providers should be taking advantage of the opportunity to begin submitting claims. The states that have gone before us were not given such a tremendous opportunity to test the waters before diving into the deep end of the pool.  This session will review the pre-claim process, including what they’re looking for in the claim, from the provider’s perspective. There will also be opportunity to discuss the good, the bad and the ugly along with lessons learned so far. Attendees of this session will leave with an understanding of the pre-claim process, have a better understanding of operational efficiencies you can implement now to ensure compliance and will have ample opportunity to ask questions.    Course Author: J'non Griffin, RN, WCC, HCS-D, COS-C, Debra Grott, RN COS-C & Kim Wilkerson, LPN  Read More

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