Home Health Request for Anticipated Payment (RAP) and Submission of the Corresponding Final Claim:
Article from Palmetto GBA:
Providers are given the greater of 120 days after the start of the episode or 60 days after the paid date of the RAP to submit the final claim. If the final claim is not submitted within the specified time, the RAP will auto-cancel and the provider must resubmit the RAP before submitting the final claim. It is expected that instances where the RAP is auto-cancelled for no submission of a final claim should be minimal.
Palmetto GBA is monitoring the number of RAPs that are auto-cancelled due to providers not filing a final claim. In accordance with Medicare regulations, contractors have the authority to revoke a provider’s privilege to receive payment on the RAP. Therefore, providers identified with a high number of RAP auto-cancels due to no final claim will be notified that their RAPs will be set to pay at zero percent. The payment suppression will continue until a Corrective Action Plan is submitted and the provider can demonstrate improvement in timely billing of final claims. We will not be withholding the RAP payment, we will simply not pay RAPs for these aberrant providers. The affected providers will only be paid for final claims.
Other providers that are identified to have RAPs auto-cancelled for no final claims that are below the acceptable threshold will be notified that their current billing practices are unacceptable and their RAPs are being monitored. If improvement is not noted within a reasonable amount of time, future RAPs may be set to pay at zero percent.
You can find the article, using the following link:
Jurisdiction 11 Home Health and Hospice: ZERO PAYMENT ON THE HOME HEALTH REQUESTS FOR ANTICIPATED PAYMENTS (RAPS) FOR PROVIDERS WITH EXCESSIVELY HIGH RAP CANCELLATION RATES AND NO FINAL CLAIMS SUBMITTED
Helpful Reports:
Reports > Billing > RAP Auto-Cancel Episodes
Reports > Billing > 14.33 PPS Claims Sent But Not Paid
Reports > Billing > 14.03 PPS Tracking Report > select RAP no EOE
Reports> Billing > 14.05 RAP Days From 1st Visit