Pre-Claim Review Choices | Using Review Choice Demonstration Data Gathering | Accessing RCD (Review Choice Demonstration) Data Gathering option | Adding Invoices to Data Gathering | Gathering/Attaching Documents | Updating the Status of the Invoice | Printing Documentation
CMS’s Review Choice Demonstration establishes a review choice process for home health services being billed to Medicare. As part of this process, agencies have the following choices available:
After 6 months, you will have additional options available to you if you meet CMS’s 90% compliance threshold. These options include:
CMS demonstration states include Illinois, Ohio, Texas, North Carolina, and Florida. This demonstration has already started for Agencies that are in Illinois, Ohio, and Texas. The current plan is for agencies in North Carolina and Florida to begin this process on January 01, 2021.
To read more about this process, you can select the following links from CMS.gov:
If you are in one of the demonstration states, be sure you have identified which review choice you are using with your MAC (Medicare Administrative Contractor).
For those agencies that are part of the demonstration process, you now have an option available that lets you collect and print all documentation you want to send to the MAC (Medicare Administrative Contractor) for your claim review. This feature will let you collect and print documentation that you want to send to the MAC (Medicare Administrative Contractor) no matter which option you choose. You must also identify the type of review you have chosen. This information now shows as a new section within the Settings tab for your agency. Click here to learn more about setting up Review Choice Agency Document Review Type.
After your initial selection for your agency, you can leave your initial choice of “Pre-Claim” or “Post Claim” review as is, or you can change your option after 6 months to “Selective Post Payment Review” or “Spot Check Review” if you meet the 90% compliance threshold. Be sure you notify your MAC (Medicare Administrative Contractor) if you make this change. Otherwise they will use Post Claim Review. Also, be sure that you end this setting and add your new one as part of your Agency settings.
Information that you want to send to the MAC (Medicare Administrative Contractor) can include any of the following documents for a Patient:
Prior to printing the documentation that you want to send to the MAC (Medicare Administrative Contractor), be sure that you complete:
To begin using the RCD Document Gathering option, go to Processes and select Review Choice Demonstration Document Gathering.
Select the drop down <btn> All ▾ <btn> to the right of Agency (defaults to All) to select your agency.
Select the drop down <btn> All ▾ <btn> to the right of Billing Status (defaults to All) to select your billing status.
Enter a date range you want to work with (defaults to the beginning of the current month to current date)
You can also search by first or last name.
You can filter by selecting the drop down <btn> All ▾ <btn> under Status.
Select the <btnw> Search <btnw> button when you have made your desired choices.
Invoices that you chose to work with display on the screen with the following information:
To add invoices to the document gathering screen select the select the <icon-greenplussign>xxx<icon-greenplussign><udl-orange>Add Invoices<udl-orange> link.
Check one or multiple invoices listed on the Add Invoices pop-up and select <btnw> Save <btnw>
After you add invoices to the Review Choice Demonstration Document Gathering screen, you want to attach/apply all documents you want to submit to the individual invoice. Use the following path to start your documentation collection:
Select the “Apply Documents” <icon-report>xxx<icon-report> icon for the invoice you want to use
Select one or multiple items from the dropdown list for each item listed as necessary (be sure you have uploaded documents and completed Service Notes you want to attach for submission) and then select the <btnw> Save <btnw> button (Detail Present column will change from “No” to “Yes”)
Prior to submitting the documentation for review, you can access this option multiple times to ensure that you have all the documentation collected for this invoice.
You can change the status of the invoice by selecting the “Edit Status” <icon-calendar>xxx<icon-calendar> icon for the invoice you want to use
Update any of the following options and then select the <btnw> Save <btnw> button </btnw></btnw>
Based on the information you entered, “Date Submitted”, “Response Date”, “Print Only”, “Not Required” and “Accepted/Rejected” columns will reflected the updated status on the “Review Choice Demonstration Document Gathering” screen.
If you chose the Pre-Claim Review option, you will receive a UTN (Unique Tracking Number) from the MAC (Medicare Administrative Contractor). Click here to learn more about adding Other Codes in the Invoices Payer Codes Tab
To print the documentation you gathered and want to submit for review, select the “Printer” icon for the invoice you want to use.
The documentation displays on your screen in a PDF format. Documentation includes a cover page that identifies the Patient, disciplines that are providing services along with a list of items selected that are being submitted for review. After the cover page, all documents print. You can use your browser functions to save/print the documentation