Home Health & Hospice Week

Tip: Watch for this UPIC letter.

The Review Choice Demonstration will not keep your agency safe from Unified Program Integrity Contractor reviews — and the steep takebacks that might accompany them. Here’s how to navigate the UPIC program when you operate under RCD.

Question: “I am a provider in an RCD state and my UPIC just ended. Now what happens?” one home health agency asked RCD contractor Palmetto GBA.

Answer: While a provider in an RCD state is under review by a UPIC, “they are excluded from the RCD program,” Palmetto confirms in an article on its website. “Providers under choice 1 [pre-claim review] (PCR) will receive a message stating that they are under a UPIC if they attempt to request a [unique tracking number] and providers under an [additional development request] option will stop receiving ADRs from Palmetto GBA,” the HHH Medicare Administrative Contractor explains.

“Once a UPIC review ends, the provider will receive a letter from the UPIC to confirm the date that the review ended. “The provider will also receive a letter from Palmetto GBA to confirm that the review has ended, but the effective date is determined by the letter from the UPIC,” the MAC acknowledges.

“If the review ends in the middle of a cycle, the provider is excluded from RCD until the next cycle begins,” Palmetto details.

For example: If an agency’s UPIC review ends on March 5 and the next RCD cycle begins on April 1, the “provider is excluded from RCD from March 5 – March 31” and the “provider will participate in RCD beginning April 1,” Palmetto offers.

Don’t miss: “Providers are expected to make a choice selection for an upcoming cycle while they are actively under a UPIC review,” Palmetto instructs. “This way, if their UPIC ends after the selection period but before the beginning of the next cycle, their selection has already been made and they can move back into the RCD program without further delay,” the contractor explains.