The industry anticipated the RCD to start in Illinois in December 2018. Through January & February we continued to see education offerings from Palmetto GBA. The delay has been tied to Office of Management & Budget approval for the project. News comes today that that approval has been granted. No details as to a start date for Illinois is available as of yet, but home health providers in that State along with Ohio, North Carolina, Florida and Texas are expected to participate in the demonstration at some point in 2019. As a reminder home health providers will be provided a choice of how they will be reviewed under this program:

  • Pre-Claim Review
  • Post Payment Review
  • Minimal Review with 25% Payment Reduction

Once you make your choice you will be required to complete the demonstration project with that choice. Additionally, in acquisition situations new owners will be required to continue under the choice that is made. We assisted a number of Illinois agencies navigate Pre-Claim Review when it was originally introduced. While the transition was extremely painful as documented in industry publications at the time, many of our clients developed an appreciation for the “peace of mind” that came from getting the medical review process out of the way and their decision to service Medicare beneficiaries corroborated during the episode. More information will be forthcoming in the near future.

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