CMS Makes Changes to the Review Choice Demonstration

Today the Centers for Medicare & Medicaid Services (CMS) announced a phased-in approach for the Review Choice Demonstration (RCD) for North Carolina and Florida. Both of these states were set to have RCD begin at the end of this month (See previous NAHC Report coverage here and here.)  CMS also posted a change to the…

Medical Review Resumes This Month

The Centers for Medicare & Medicaid Services (CMS) will resume medical revnew this month after originally delaying the program during the COVID-19 public health emergency (PHE). (NAHC Report originally reported this news on July 9.) On March 30, CMS suspended most Medicare Fee-For-Service (FFS) medical review because of the COVID-19 pandemic and, seemingly, for the…

Florida Reps Urge CMS to Delay Review Choice Demonstration in Florida

A trio of Representatives from Florida have sent a letter to the Centers for Medicare and Medicaid Services (CMS) expressing concerns with the decision to move forward with the Review Choice Demonstration (RCD) program in Florida. In March, due to the burgeoning COVID-19 pandemic, CMS announced that the RCD program would be paused from expansion…

Hospice PEPPER Available & Key CMS Updates for Hospice & Home Care in New Open Door Forum

Hospice PEPPER Available The Hospice PEPPER (Program for Evaluating Payment Patterns Electronic Report) is now available. PEPPER is a data report that contains a single hospice’s claims data statistics (obtained from the UB-04 claims submitted to the Medicare Administrative Contractor (MAC)) for areas targeted by CMS as being at risk for improper Medicare payment. Each…

CMS To Resume Medical Review Activities, Including Review Choice Demonstration

The Centers for Medicare & Medicaid Services (CMS) has announced the return of medical review activities, including the Review Choice Demonstration (RCD) program for home health services on August 3, 2020, regardless of the status of the Public Health Emergency (PHE). On March 30 the Centers for Medicare & Medicaid Services (CMS) suspended most Medicare…

NAHC Asks CMS/HHS for Reg Flexibility to Fight COVID-19

The National Association for Home Care & Hospice (NAHC) has made a series of requests to the Centers for Medicare & Medicaid Services (CMS) for regulatory action designed to enable home health and hospice to fulfill its potential as the health care setting most suited to stopping the spread of the novel coronavirus COVID-19 while…

CMS Issues New Waivers under the Conditions of Participation

The Centers for Medicare & Medicaid Services (CMS) has waived some significant provisions of the home health Conditions of Participation. The following items under the CoP have been waived by CMS. The initial evaluation under 484.55 (a) will not require an on-site visit and may be conducted remotely or through medical review. This does not…

Open Door Forum Summary: Updates on iQIES Transition Update and Home Health & Hospice

The Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice, & DME Open Door Forum (ODF) on January 8, 2020.  A summary is provided below, beginning with home health and followed by hospice. HOME HEALTH iQIES Transition CMS indicated in the ODF that it is aware of several issues with the iQIES…

CMS Updates Review Choice Demonstration FAQs to Address PDGM

The Centers for Medicare & Medicaid Services (CMS) has updated the Frequently Asked Questions (FAQs) and the Operational Guide for the Review Choice Demonstration(RCD)to include additional information on how the Patient-Driven Groupings Model (PDGM) will affect the demonstration. CMS updated the Operational Guide in early December  to include instructions for submitting documentation relate to PDGM,…

Important Information for all HHA in Review Choice Demonstration under PDGM

For those home health agencies that are part of the Review Choice Demonstration and have selected the Pre-claim Review (PCR) option, the long awaited CMS update confirming that HHAs will need to submit a PCR for each 30-day billing period has been posted.  CMS updated the RCD Operational Guide, Chapter 6, with the following: For…