RCD Illinois Transition to Cycle 4
As the Review Choice Demonstration (RCD) for home health agencies (HHAs) in Illinois continues, the time for Cycle 4 is approaching.
If an HHA's full affirmation rate or claim approval rate is 90 percent or greater for the previous six-month period, it may choose one of the subsequent review options:
- Choice 1: Start or continue participating in pre-claim review (PCR) for another cycle;
- Choice 4: Selective postpayment review of a statistically valid random sample (SVRS) of claims every six months for the remainder of the demonstration; or
- Choice 5: Spot Check Review of five percent of claims every six months to ensure continued compliance
Note: If an HHA is eligible for a subsequent review option, but does not make a selection during the selection period, the HHA will be placed in Choice 4.
If an HHA’s full affirmation rate or claim approval rate is less than 90 percent for the previous six-month period, it may choose one of the initial review options:
- Choice 1: Start or continue participating in PCR for another cycle;
- Choice 2: 100 percent postpayment review; or
- Choice 3: Minimal post payment review with 25 percent payment reduction
Note: If an HHA is eligible for an initial review option, but does not make a selection during the selection period, the HHA will be placed in Choice 2.
For those options that are evaluated every six months, the claims or PCR requests reviewed during the cycle will determine the provider’s results. Providers will continue in their selected option during the calculation and selection period. The affirmation/claim approval rate calculation period occurs during the month of June 2021 with results letters being sent to HHAs by the end of June 2021. The selection period for Cycle 4 will take place from July 1, 2021, through July 18, 2021. HHAs that do not make a selection during that time period will default to either Choice 2 or Choice 4 as noted earlier in this article.
As providers transition from Cycle 3 to Cycle 4, please be advised of the actions required when changing from one choice to another.
If Your |
And Your Cycle 4 Choice is: |
Here are the actions you will need to take: |
Choice 1: PCR |
Choice 1: PCR |
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Choice 1: PCR |
Choice 2: Postpayment Review |
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Choice 1: PCR |
Choice 3: Minimal Review |
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Choice 1: PCR |
Choice 4: Selective Postpayment Review |
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Choice 1: PCR |
Choice 5: Spot Check |
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Choice 2: Postpayment Review |
Choice 1: PCR |
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Choice 2: Postpayment Review |
Choice 2: Postpayment Review |
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Choice 2: Postpayment Review |
Choice 3: Minimal Review |
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Choice 2: Postpayment Review |
Choice 4: Selective Postpayment Review |
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Choice 2: Postpayment Review |
Choice 5: Spot Check |
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Choice 5: Spot Check |
Choice 1: PCR |
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Choice 5: Spot Check |
Choice 2: Postpayment Review |
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Choice 5: Spot Check |
Choice 3: Minimal Review |
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Choice 5: Spot Check |
Choice 4: Selective Postpayment Review |
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Choice 5: Spot Check |
Choice 5: Spot Check |
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