Call 855.485.QIRT for more information

Call 855.485.QIRT for more information

Review Choice Demonstration (RCD) for Home Care Agencies

CMS recently announced a restart to the pre-claim review (PCR) demonstration project for home care agencies in five states:

  1. Illinois is to start this on December 10, 2018, with Florida, Texas, Ohio, and North Carolina to follow. 

  2. While CMS has changed the prior Pre-Claim Review options, most affected agencies will opt for 100% pre-claim submission. 

  3. Prior experience with PCR often showed agencies required an 1.5 additional FTEs (1 RN and 1 clerical) for every 100 patient census.

  4. Since all claims are subject to this process there is a significant new administrative burden to factor into your daily operational costs.

  5. This involves collecting, organizing, submitting, and tracking some content for every claim submitted--not just new admissions.

  6. Key to success is to get the PCR submission approved the first time, to avoid the lengthy need for resubmissions while service continues to be provided. 

  7. If the agency chooses post-payment submission for their RCD reviews, this task will consist of completing Additional Development Requests (ADRs) for 100% of their claims: an even larger administrative burden.

  8. Consider outsourcing this service to QIRT.  

The Home Care Agency Solution 

Computer and tablet with words QIRT RCD TASK TOOL

QIRT has formed a highly trained and credentialed Review Choice Demonstration (RCD) Team. This team is specifically trained to review the documentation in the patient medical record related to CMS' requirements.

The team will the RCD Task Tool that will alert the agency that:

  • All documentation is in one place and the agency can submit to the intermediary OR 
  • One or more pieces of documentation is still needed before submission. 

The team will work with the agency to put the required documentation in one place, submitted timely, and remove this additional burden from agency staff--allowing them to spend their efforts caring for their patients and not shuffling paperwork.


QIRT can provide:

  • Coding/OASIS review to ensure that coding and assessment documentation correlate to the physician face-to-face (F2F) encounter and need for home care.
  • Pre-claim review only.
  • Coding/OASIS review, and then pre-claim review.
  • Billing the Request for Anticipated Payment (RAP) with a review of documentation present at the time of RAP.
  • Assistance with ADRs (if post-payment review option is selected by the home health agency): review and submission.

 

Let QIRT be your Review Choice Demonstration solution. 

  • Free your staff to focus on what is necessary and important:
  • Provision of care 
  • Documentation of care necessary for an auditor to form a true picture about the specific patient
  • The care that is needed by the patient, provided by the agency, and documented by the clinician.

Contact Us

QIRT leads the post-acute industry in coding, billing, and consulting. Serving agencies across the United States, QIRT provides multi-level coding/MDS/UAS reviews, quality assurance, appeals, outsourced billing, consulting, and education.

15 Verbena Avenue, Suite 210, Floral Park, NY 11001

855.485.QIRT (7478)

855.485.QIRT (7478)

516.706.3341

516.706.3341

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