The following process can be used for patients you know will have a LUPA episode you can bill accordingly; or for payers who do not pay RAPs.
This process will allow you to only bill the EOE and therefore will skip the process of have the RAP taken back and adjusted on LUPA episodes.
All of the normal documentation will need to be complete before the EOE is created, just like all other claims. So make sure you have the OASIS completed and locked or transmitted, 485 and orders must be returned and signed by the physician, Face to Face must be complete, all assessments must be complete and entered in Barnestorm.
- Create the RAP billing as you normally would - separate from any other episode. Do not send it to the payer.
- You can go to Billing > HIPAA Transactions > Edit Serial Numbers and select the RAP batch to mark it as “Transmitted, Accepted”.
- Create the EOE – when selecting episodes make sure the box “RAP Paid Only” is not checked.
- If the episode shows up on the error list then you will need to correct the errors or wait for documentation to be complete.
- Send the EOE Claim to the payer as usual.
- The patient’s episode will be marked as a status of EOE Sent, Not Paid
- If the episode has the number of visits that is specified for that HIPPS code as LUPA, it will be marked as a LUPA. Otherwise, it will not be marked as LUPA.