Home Health

Illinois agencies starting next round of Review Choice Demonstration

Agencies in Illinois are starting the second round of the Review Choice Demonstration (RCD).

The second cycle of RCD in Illinois runs from Feb. 1 through July 31.

Illinois agencies with a full affirmation rate or claim approval rate of 90% or higher during the first six months of RCD were able to choose one of the subsequent review options:

  • Start or continue participating in pre-claim review for another cycle;
  • Selective post-payment review of a statistically valid random sample of claims every six months for the remainder of the demonstration; or
  • Spot-check review of 5% of claims every six months to ensure continued compliance.

Agencies with affirmation rates or claim approval rates less than 90% during the first six months were able to select one of the initial review options:

  • Start or continue participating in pre-claim review for another cycle;
  • 100% post-payment review; or
  • Minimal post-payment review with 25% payment reduction.

Agencies will continue with the selected option during the evaluation and selection periods. Evaluation happens during the seventh month, and at the end of that month, agencies in an eligble option have two weeks to select their choice for the next six months.

Learn more about the transition between cycles and any actions needed if changing to a new choice: http://bit.ly/2Hfxk28.