Review Choice Demonstration: Non-Affirmations When Transitioning from Pre-Claim Review to Spot Check

Published 07/30/2021

During the two months between cycles of the Review Choice Demonstration (RCD), a home health agency (HHA) could receive a non-affirmation determination for a pre-claim request without the time to achieve a full affirmation. If this occurs, the HHA is instructed to file the final claim which will generate an Additional Documentation Request (ADR). Regardless of the ADR decision, the HHA will have a non-affirmed decision counted in their rate calculation for the new cycle and the ADR determination. To avoid this, HHAs should leave ample time to resubmit in order to achieve a full affirmation prior to changing choice selections. HHAs are encouraged not to hold claims during this time.

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