On April 24, 2024, Novitas Solutions hosted their first webinar for inpatient rehabilitation facilities (IRF) in preparation for the start date of the IRF Review Choice Demonstration (RCD) in Pennsylvania on June 17, 2024. Novitas is the RCD contractor for the state of Pennsylvania. The webinar provided an overview of the process, the different review choices, and the instructions for contractor-specific portal (Novitasphere). While the webinar primarily covered the basics of the program as previously laid out in CMS’s materials, there was some new information that was shared:
- For the first time, Novitas introduced the clinical leadership team for the demonstration in Pennsylvania:
- Ene Ojile, the Contract Medical Director overseeing the RCD in Pennsylvania. Dr. Ojile is Board-Certified in Physical Medicine & Rehabilitation (PM&R), and she most recently served as Medical Director for a large freestanding inpatient rehabilitation hospital.
- Jessica Hicks, RN, MSN, the Medical Review Manager.
- Mia Jackson, RN, BSN, the Medical Review Team.
- There was some discussion and confusion about the methodology Novitas will use to calculate individual hospital’s affirmation rates under the RCD. During the webinar, Novitas staff stated that the total number of submissions and resubmissions would be included in the calculation, potentially penalizing hospitals for completing resubmissions even if the claim is eventually affirmed. After the webinar, Novitas circulated a “clarification” indicating that, “The number of resubmissions is not counted against the affirmation rate.” Additional clarification will be requested to confirm how the rates will be calculated and that the same methodology will be used as in Alabama.
The slides from the April 24 webinar are now available, and Novitas has also posted a recording of the main presentation (without the public Q&A portion) available here.
Novitas will also be hosting the following training and education webinars leading up to the start date. You can register for these webinars at their website.
- May 2 — Review Choice Selection & Process (PA IRF Providers Only)
- May 3 — RCD: How to Prepare (All JH and JL IRF Providers)
- June 4 — Pre-Claim and Post-Payment Review Submissions (PA IRF Providers Only)
