I Am a Provider in an RCD State and My UPIC Review Just Ended. Now What Happens?

While the Review Choice Demonstration (RCD) is under way in your state, providers under review by a Unified Program Integrity Contractor (UPIC) are excluded from the program. Providers under Choice 1 (Pre-Claim Review) will receive a message indicating they are under UPIC review if they attempt to submit a Pre-Claim Review. Providers under an Additional Documentation Request (ADR) option will not receive ADRs from Palmetto GBA.

Once a UPIC review ends, providers should receive a letter from the UPIC confirming the date the review ended. If the review ends in the middle of a cycle for your state, your location is excluded from RCD until the next cycle begins.

Example

• The UPIC review ends on March 5
• The next cycle begins on April 1
• Provider is excluded from RCD from March 5–31
• Provider will participate in RCD beginning April 1

Important Notes

1. Providers are expected to make a choice selection for an upcoming cycle while they are actively under a UPIC review. If the UPIC review ends after the selection period but before the beginning of the next cycle, providers will start the RCD program cycle without delay.
2. Providers will also receive a letter from Palmetto GBA confirming the conclusion of the UPIC review. Please note, the effective date is determined by the letter sent by the UPIC.
3. All claims submitted with a date of submission on or after the start of the next cycle are subject to the demonstration

Additional Resources

• Providers Under a UPIC Review Do Need to Make an RCD Selection (PDF)
• Jurisdiction J Part A — Inpatient Rehabilitation Facility Review Choice Demonstration Additional Documentation Request Process (palmettogba.com)
• Review Contractor Directory — Interactive Map
• Review Choice Demonstration (RCD) for Inpatient Rehabilitation Facility Services Frequently Asked Questions (FAQs) (PDF) (cms.gov) — Questions 20 and 21 (PDF)