';
CLOSE
Tags Posts tagged with "rcd"

rcd

0 999

Novitas Solutions has released the Cycle 2 results for the inpatient rehabilitation facility (IRF) review choice demonstration (RCD). The Cycle 2 results letters were issued on September 10, 2025, and are available in Novitasphere.

IRFs will have a 2-week choice selection period for Cycle 3 from October 7, 2025 – October 20, 2025, using the Novitasphere portal.

Cycle 3 Choice Selection Options

If the approval rate meets or exceeds target affirmation rate of 85% for Cycle 2 (based on a minimum of 10 submitted pre-claim review requests or claims), the IRF may select 1 of the 3 subsequent review choices:

  • Choice 1: Pre-claim review (PCR)
  • Choice 3: Selective post-payment review (default if no review choice is made)
  • Choice 4: Spot check prepayment review

If the IRF’s affirmation or claim approval rate is less than the target affirmation rate or they have not submitted at least 10 requests/claims, the IRF must again choose from 1 of the initial 2 options:

  • Choice 1: Pre-claim review (PCR)
  • Choice 2: Post-payment review (default if no review choice is made)

Cycle Stats Reminder

IRFs can access information about their affirmation/approval rate at any given time during the current or previous review cycle through the Cycle Stats option in Novitasphere. Visit here for more information on cycle stats.

IRF RCD Questions

Questions or concerns regarding the IRF RCD should be directed to the IRF Customer Service line at 855-340-5975, Monday – Friday, 8:00 am – 6:00 pm.

IRF RCD Resources and Educational Opportunities

Visit the Inpatient Rehabilitation Facility (IRF) Review Choice Demonstration (RCD) web page for important information about the IRF RCD and upcoming educational events, including a recording of the September 24, 2025, webinar on IRF RCD: Cycle 2 Results and Transitioning to Cycle 3.

Important Deadlines

  • October 7, 2025 – October 20, 2025, Cycle 3 Choice Selection
  • November 1, 2025 – April 30, 2026, Cycle 3 Review Dates
  • On or before May 30, 2026, Cycle 3 Affirmation/Approval Rate Communication

0 1548

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:

  1. 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.
  2. 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)

0 2073

On March 1, 2024, the Centers for Medicare and Medicaid Services (CMS) posted an update on the Review Choice Demonstration for Inpatient Rehabilitation Facility (IRF) Services web page that announced they will be expanding the Review Choice Demonstration for IRF services in Pennsylvania on June 17, 2024. The demonstration will apply to IRF admissions occurring on or after June 17, 2024. IRF admissions prior to the June 17 date are not part of the demonstration, and IRF providers must select either 100% pre-claim review or 100% post-payment review between May 3, 2024, and June 2, 2024.

Medicare Administrative Contractor (MAC) for Jurisdiction L (which includes the state of Pennsylvania) is Novitas Medicare Solutions, who processes claims for IRFs located in Pennsylvania. Novitas will be directly involved in the RCD and created a dedicated RCD page on their website. The page includes additional information on background and general information, timelines, the two choices for claims review (pre-payment and post-payment), IRF RCD contact information, educational events, and other resources.

The IRF RCD began in Alabama in August 2023. CMS has cited that creating a review choice process will ensure Medicare coverage and documentation requirements are likely met. CMS feels this program will reduce the number of Medicare appeals, improve provider compliance with Medicare program rules, does not alter the Medicare IRF benefit, and should not delay medically necessary care to Medicare beneficiaries.

RCPA will continue to update members as additional information is received. Members are encouraged to review the information on the CMS RCD web page and Novitas RCD web page. Questions regarding this information can be directed to Melissa Dehoff.

© 2021 - Rehabilitation & Community Providers Association