While the Patient-Driven Groupings Model (PDGM) has dominated the home health agency landscape in recent months, agencies in several states are also looking ahead to more change coming in 2020 with respect to the Review Choice Demonstration (RCD).
Scheduled to take effect next in the first half of 2020 in Texas, North Carolina and Florida — and previously implemented in Illinois and Ohio — the RCD is requiring those agencies it impacts to shore up their business practices in preparation for the reviews they choose. For many, it will mean implementing technology to help adapt efficiently and effectively to the new process.
“We want to make sure providers aren’t waiting to see what happens,” says James Ryan, vice president of sales for home health technology provider eSolutions. “Otherwise, they could be digging out of a hole.”
Preparing for RCD
Some agencies that will be impacted by RCD are taking steps to prepare now, and those operating in states where RCD has taken effect are already developing new processes and partnerships to aid in the claims process. Namely, they are utilizing new technology offerings.
At Graham Healthcare Group, based in Troy, Michigan, the company has long had a manual process for its claims reviews. The company provides home health and hospice care in three states including Michigan, Pennsylvania, and Illinois — where the RCD took effect in June 2018.
The company, which supports a census of around 10,000 home health patients across several states, elected a 100% full audit to ensure documents were up to par during any organizational changes, finding the manual process has been very time consuming. It had been using eSolutions for some of its revenue cycle management needs, based on eSolutions’ expertise in the Medicare reimbursement payment landscape.
Given the time consuming nature of claims review, Graham was seeking a solution to help with the Review Choice Demonstration.
“What eSolutions is offering is to get more interaction and feedback to HomeCare HomeBase,” says Megan Zannetti, vice president of revenue cycle management. “We haven’t utilized yet but we are hoping it will save time.”
In order to help agencies gain efficiencies with respect to Review Choice, eSolutions provides a portal for submitting pre-claim option documentation. Broadly, RCD presents agencies with multiple options for how they participate, with pre-claim proving to be the most popular by far.
“This will allow them to cut submission time in half based on some of the autofill information we have on the organizations,” Ryan says. “It will allow us to skip some steps.”
Additionally, some agencies may not have dealt previously with additional documentation requests (ADRs), and the platform helps them manage these requests and respond to them in a timely manner.
“Some of the companies have never dealt with ADRs before if they have not been part of ‘Probe and Educate,’ and they may not have a good way to [manage the requests],” Ryan says.
Once providers achieve a 90% affirmation rate over a 6-month period, they face a choice: Do they prefer to remain on pre-claim review to reduce the risk and cash flow challenges associated with ADRs? Or would they rather transition to the ADR option to eliminate the onerous process of managing the pre-claim submissions?
“Many of our customers have decided to remain on pre-claim review because we can help them take advantage of the best of both options,” Ryan says. “Our services allow providers to avoid the risks associated with ADRs while still saving precious time by automating otherwise time-consuming tasks involved in the pre-claim review submission process.”
As the payment landscape tightens further under the PDGM, agencies are having to adjust to many new processes at once. In fact, the unrealistic timing proximity of PDGM and RCD was the main reason the Centers for Medicare & Medicaid Services (CMS) delayed implementation in Texas; RCD was originally scheduled to start there in December.
The eSolutions platform can help save time for those in Review Choice Demonstration states as they face shorter reimbursement timelines overall.
“As we get more data … we will be able to give more insight into analytics,” Ryan says. “In the beginning, the intuitive interface for submission will cut the time in half.”
For more than two decades eSolutions has worked to strengthen providers’ revenue health so they can focus on what really matters – their patients’ health and well-being. We accomplish this by delivering the best RCM tools for physicians and providers in hospital, home health, hospice, health center, skilled nursing/long-term care and durable medical equipment markets. Learn more.
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