North Carolina and Florida RCD Transition Cycle 2


As the Review Choice Demonstration (RCD) for home health agencies (HHA) in North Carolina and Florida continues, the time for Cycle 2 is approaching.

If an HHA's full affirmation rate is 90 percent or greater for the first six-month period (Cycle 1), 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 a 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 1 - PCR.

If an HHA’s full affirmation rate is less than 90 percent for the first six-month period (Cycle 1), 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
  • Choice 3: Minimal postpayment 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 1 - PCR.

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 rate calculation period occurs during the month of March 2021 with results letters being sent to HHAs by the end of March 2021.  The selection period for Cycle 2 will take place from April 1, 2021 through April 15, 2021.  HHAs that do not make a selection during that time period will default to Choice 1 as noted earlier in this article.

Claims submitted without going through the pre-claim review process will process as normal and will not be subject to a 25% payment reduction. These claims may be subject to postpayment review in the future through the normal medical review process.

Transition Timeline

Table of transition dates
 
As providers transition from Cycle 1 to Cycle 2, please be advised of the actions required when changing from one choice to another.

 

If Your
Cycle 1
Choice was:

And Your Cycle 2 Choice is:

Here are the actions you will need to take:

Choice 1: PCR

Choice 1: PCR

1.  Continue PCR process. Data from March and April will be included in the Cycle 2 results.

Choice 1: PCR

Choice 2: Postpayment Review

1. Continue to submit PCR requests through 4/30/2021. Data from March and April will be included in the Cycle 2 results.
 

a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed).


2. As of 5/1/2021, submit final claim.


a. ADR will not generate.

Choice 1: PCR

Choice 3: Minimal Review

1. Continue to submit PCR requests through 4/30/2021. Data from March and April will be included in the Cycle 2 results.


a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed).


2. As of 5/1/2021, submit final claim.


a. ADR will not generate.

Choice 1: PCR

Choice 4: Selective Postpayment Review

1. Continue to submit PCR requests through 4/30/2021. Data from March and April will be included in the Cycle 2 results.


a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed).


2. As of 5/1/2021, submit final claim for payment.


a. ADR will not generate.

Choice 1: PCR

Choice 5: Spot Check

1. Continue to submit PCR requests through 4/30/2021. Data from March and April will be included in the Cycle 2 results.


a. Add UTN to claims if PCR was submitted (regardless if affirmed or non-affirmed).


2. As of 5/1/2021, submit final claims.


a. ADRs will not generate.

Choice 2: Post Payment Review

Choice 1: PCR

1. Begin submitting PCR requests on 5/1/2021 for any claim that will be submitted on or after 5/1/2021 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

1.  Continue to submit final claims.

 

a. ADRs will not generate.

Choice 2: Postpayment Review

Choice 3: Minimal Review

1.    Continue to submit final claims.

 

a. ADRs will not generate.

Choice 2: Postpayment Review

Choice 4: Selective Postpayment Review

1.    Continue to submit final claims.

 

a. ADRs will not generate.

Choice 2: Postpayment Review

Choice 5: Spot Check

1.    Continue to submit final claims.

 

a. ADRs will not generate





Last Updated: 04/05/2021