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RCD: What you need to know

RCD: What you need to know

KanTime and Inovalon are helping home health agencies (HHAs) better understand Review Choice Demonstration (RCD) and how it may impact their reimbursement.

What is the RCD update?

Review Choice Demonstration (RCD) is an initiative that the Centers for Medicare & Medicaid Services (CMS) created to identify and prevent fraud and abuse in Medicare’s Home Health benefit program.

RCD first began on June 1, 2019, and is effective until May 31, 2024. And while RCD is being tested in only a few pilot states so far (Illinois, Ohio, Texas, North Carolina and Florida), it could soon expand to include other states.

Why is it important?

RCD plays a valuable role in helping HHAs develop procedures that identify and prevent fraud, protect beneficiaries, and safeguard taxpayer dollars while empowering patients and reducing provider burden.

CMS is conducting RCD to:

  • Ensure home health service payments are made correctly and on time
  • Protect Medicare funding
  • Reduce Medicare appeals
  • Increase provider compliance with Medicare requirements

How does it work?

RCD requires an HHA to submit claims for review. It does not require any new or additional documentation, as the same claims the HHA already maintains are the claims that will be submitted.

The demonstration is split into two phases (Phase 1 and Phase 2), and each phase offers three different claims submission options to choose from. The option you choose during each phase impacts your reimbursement, your time, and your RCD submission process overall.

These options give an HHA the flexibility to choose its own path for demonstrating compliance.

Phase 1

The three claims submission options in the initial phase, Phase 1, are pre-claim review, post-payment review and minimal review with a 25% payment reduction.

For more details on these options, read our RCD white paper.

Phase 2

In the subsequent phase, Phase 2, the claims submission options are pre-claim review, selective post-payment review and spot check review.

IMPORTANT: The selection you make in Phase 2 is where you stay for the remainder of the demonstration.

For more details on these options, read our RCD white paper.

Who delivers the highest level of RCD support?

KanTime and Inovalon’s connected technology delivers the greatest level of RCD support by simplifying RCD and driving the high performance behind your RCD management.

KanTime’s EMR supports HHAs in tracking affirmation of all patients who require review submission. Inovalon’s ABILITY EASE® esMD application provides the clearinghouse that allows you to gather all documentation to efficiently submit into FISS/DDE and easily track the submission status.

Together, our integrated RCD management solutions ensure your reimbursements, save you time and prevent submission errors. More specifically, you’ll get affirmation of RCD documentation with detailed tracking of all RCD submissions.

Have questions?

We understand that RCD is new and you probably have lots of questions. The good news is that we’ve got answers. Lots of them. View our free RCD webinar to get a quick RCD overview from Inovalon’s senior RCM training specialist. Learn more about the KanTime and Inovalon partnership here.

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