Illinois Home Health Agencies (HHAs) to Begin Review Choice Demonstration (RCD) Cycle 3

Published 09/22/2020

Palmetto GBA is providing important information for Illinois HHAs as they prepare to begin Cycle 3 of the Review Choice Demonstration on December 1, 2020.

Cycle Transition Timeline

  • Cycle 2 Ends: September 30, 2020
  • Cycle 2 Analysis: October 2020
  • Notification of Cycle 2 Results: Delivered by October 31, 2020
  • Cycle 3 Selection: November 1, 2020 – November 15, 2020
  • Cycle 3: December 1, 2020 – May 31, 2021

As you transition from Cycle 2 to Cycle 3, please be advised of actions you need to take.

If Your Cycle 2 Choice was:
And Your Cycle 3 Choice is:
Here are the actions you will need to take:
Choice 1: PCR
Choice 1: PCR
Continue PCR process. Data from October and November will be included in the Cycle 3 results.
Choice 1: PCR
Choice 2: Postpayment Review
1. Continue to submit PCR requests through 11/30/2020
a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed)
b. Respond to ADRs as generated
2. As of 12/1/2020, submit final claim for payment
a. Include UTN if a PCR request was submitted prior to 12/1/2020 and a UTN was received
b. Final bill will adjust, and the ADR will generate
c. Respond to ADR
Choice 1: PCR
Choice 3: Minimal Review
1. Continue to submit PCR requests through 11/30/2020
a. Add UTN t claims if PCR was submitted (regardless if affirmed or non-affirmed)
b. Respond to ADRs as generated
2. As of 12/1/2020, submit final claim
a. ADR will not generate
b. 25% reduction will apply
Choice 1: PCR
Choice 4: Selective Postpayment Review
1. Continue to submit PCR requests through 11/30/2020
a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed)
b. Respond to ADRs as generated
2. As of 12/1/2020, submit final claim for payment
a. Include UTN if a PCR request was submitted prior to 12/1/2020 and a UTN was received
b. Final bill will adjust, and the ADR will generate
c. Respond to ADR
Choice 1: PCR
Choice 5: Spot Check
1. Continue to submit PCR requests through 11/30/2020
a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed)
b. Respond to ADRs as generated
2. As of 12/1/2020, submit final claim
a. Include UTN if a PCR request was submitted prior to 12/1/2020 and a UTN was received
b. Final bill will adjust, and the ADR will generate
c. Respond to ADR
Choice 2: Postpayment Review
Choice 1: PCR
1. Continue to respond to ADRs

2. Begin submitting PCR requests on 12/1/2020 for any claim that will be submitted on or after 12/1/2020 with a date of service on or after 8/31/2020
a. Add UTN to claims for claims with PCR requests
Choice 2: Postpayment Review
Choice 2: Postpayment Review
Continue to respond to ADRs. Data from October and November 2020 will be included in the Cycle 3 results.
Choice 2: Postpayment Review
Choice 3: Minimal Review
1. Continue to respond to ADRs sent for Choice 2
 
2. As of 12/1/2020, submit final claim
a. ADR will not generate
b. 25% reduction will apply
Choice 2: Postpayment Review
Choice 4: Selective Postpayment Review
Continue to respond to ADRs.
Choice 2: Postpayment Review
Choice 5: Spot Check
Continue to respond to ADRs.
Choice 5: Spot Check
Choice 1: PCR
1. Continue to respond to ADRs
 
2. Begin submitting PCR requests on 12/1/2020 for any claim that will be submitted on or after 12/1/2020 with a date of service on or after 8/31/2020
a. Add UTN to claims for claims with PCR requests
Choice 5: Spot Check
Choice 2: Postpayment Review
Continue to respond to ADRs.
Choice 5: Spot Check
Choice 3: Minimal Review
1. Continue to respond to ADRs sent for Choice 5
 
2. As of 12/1/2020, submit final claim
a. ADR will not generate
b. 25% reduction will apply
Choice 5: Spot Check
Choice 4: Selective Postpayment Review
Continue to respond to ADRs.
Choice 5: Spot Check
Choice 5: Spot Check
Continue to respond to ADRs. Data from October and November 2020 will be included in the Cycle 3 results.


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