On January 16, the Centers for Medicare and Medicaid Services (CMS) released updated statistics on the home health review choice demonstration (RCD) which helps ensure through either pre-claim review or postpayment review that payments for home health services are appropriate.
The new data released states that the current Medicare Administrative Contractor (MAC) accuracy rate for this program is 100% compared to FY2022 which was 99.5%. MAC timeliness has also improved from 6.3 days in FY2022 to 4 days in FY2023. However, the percentage of affirmed requests has decreased from 96.2% to 85.5% and the percentage of claims overturned on level 1 appeal also decreased from 42% to 35.4%. Agencies are only relieved from claims review when they reach the 90 percent target affirmation or claim approval rate, except for spot checks to ensure continued compliance. The program is currently implemented in Illinois, Ohio, Texas, North Carolina, Florida, and Oklahoma. Some of these changes may be due to the addition of Oklahoma providers last year.
On May 17, 2024, CMS announced that the demonstration will be extended for an additional five years effective June 1, 2024.
