![]() As a result, the claim and OASIS diagnosis codes will no longer be expected to match in all cases. For from dates after January 1, 2021, the ICD code and principal diagnosis used for payment grouping will be claim coding rather than the OASIS item. Q: What Diagnosis Codes (DX codes) need to be reported on RAPs?Ī: Only principal diagnosis (DX) is required. Q: What are the changes to the first billable visit requirement?Ī: The first billable visit for the episode will satisfy the requirement for both the first and second 30-day billing period RAPs. Q: Are there any changes to the automatic RAP cancellation process?Ī: RAPs will no longer be subject to auto cancellation. If you have a grouper that can generate a HIPPS code, that can work. Q: How will the HIPPS code be determined on the RAP if the OASIS is not required to be complete?Ī: This HIPPS code reported on the RAP is no longer required to match the HIPPS code calculated on the assessment. Here are two great links to videos that explain things also. If a RAP is not submitted timely, in the case of a LUPA, any visit made prior to the RAP submission will not be paid. ![]() This saves a lot of time and administrative burden. That means, get the RAP in! You can submit a RAP for both early and late episodes at the same time. The penalty would be $560 for a late RAP submission. If a RAP is submitted on day 6, there would be a penalty of 6/30's of the reimbursement rate. If you divide that by 30 days, that comes to a daily rate of $93.33. Here's how it will work: Say a patient reimbursement is $2800. If the RAP is submitted late, then a penalty of 1/30 of the 30 day calculated payment. ![]() Agencies only have 5 days to submit a RAP and it must be ACCEPTED by the MAC. Here is where a BIG departure from the previous process. (Best practice would be to use a code out of the appropriate grouper (cardiac patient, cardiac code), but any will work as long as the codes match on final billing. 3- HIPPS code (any valid HIPPS code will work- must match at RAP and final billing) 4- Any PDGM compliant diagnosis code. Here is what is required for RAP in 2021: 1- Verbal or written order (must be documented) for home health care. There are big changes from RAP in 2021 vs 2020. It resembles much closer to the process in hospice that is a Notice of Election (NOE)- which informs CMS that hospice care will be starting. In terms of managed care, a RAP is how home health is authorized and establishes the episode. In effect, the RAP is simply establishing care with a home health agency. Beginning in 2021, there will be no payment associated with a RAP. One of the biggest misconceptions of RAP process in 2021 is actually the name. However, under PDGM, there are now two 30 day billing periods instead of one 60 day period. In 2020, CMS reduced the RAP to 20% of the anticipated payment at the beginning of the episode and 80% at the final bill. With PDGM and CMS No Pay RAP, agencies are concerned. The helped agencies with cash flow to cover the cost of care during the 60 day episode. Prior to PDGM implementation in 2020, a RAP was 60% of the anticipated payment over 60 days up front and then the remaining 40% at the final bill. For many years, CMS allows agencies to submit a RAP, which means Request for Anticipated Payment. ![]() As if things weren't complicated enough between PDGM and COVID, CMS issued a new rule which has thrown many home health agencies for a loop. ![]()
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