If the RAP that corresponds to a claim was originally received timely, but the RAP was canceled and resubmitted to correct an error, enter remarks to indicate this condition (for example, “Timely RAP, cancel and rebill”). Append modifier KX to the HIPPS code reported on the revenue code 0023 line.
Full Answer
Is a rap considered a claim for Medicare?
While a RAP is not considered a claim for purposes of Medicare regulations, it is submitted using the same formats as Medicare claims. The Social Security Act at §1862 (a)(22) requires that all claims for Medicare payment must be submitted in an electronic form specified by the Secretary of Health and Human Services, unless an exception
When does Medicare stop paying for raps?
The RAP payment, for RAPs with “From” dates prior to January 1, 2021, will be canceled automatically by Medicare if the final claim is not submitted 60 days after the calculated end date of the period of care (day 90) or 60 days after the paid date of the RAP (whichever is greater).
What is the Medicare rap rate for home health agencies?
The first payment in response to the RAP is 20 percent. The second payment in response to the final claim is 80 percent. NOTE: Home health agencies newly enrolled in Medicare on or after January 1, 2019 will not receive split percentage payments beginning in calendar year 2020. Refer to MLN article SE19005 for additional information.
Can I submit raps for multiple periods of care at once?
If the plan of care dictates multiple 30-day periods of care will be required to effectively treat the beneficiary, you may submit RAPs for both the first and second 30-day periods of care, for a 60-day certification or recertification, at the same time.
How do I correct a Medicare billing error?
If the issue is with the hospital or a medical provider, call them and ask to speak with the person who handles insurance. They can help assist you in correcting the billing issue. Those with Original Medicare (parts A and B) can call 1-800-MEDICARE with any billing issues.
What is a rap in Medicare billing?
Submitting a Request for Anticipated Payment (RAP) under the Home Health Patient-Driven Groupings Model.
Does Medicare accept corrected claims electronically?
You can send a corrected claim by following the below steps to all insurances except Medicare (Medicare does not accept corrected claims electronically). To submit a corrected claim to Medicare, make the correction and resubmit it as a regular claim (Claim Type is Default) and Medicare will process it.
How long do you have to correct a claim with Medicare?
Medicare claims must be filed no later than 12 months (or 1 full calendar year) after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't pay its share.
How do you cancel a rap on DDE?
Claim cancellation process If you need access to FISS/DDE, please refer to the Electronic billing products & services: Direct data entry (JH)(JL) document located on our website. The claims correction, option 03, allows you to cancel paid claims in a status location P B9997.
Does the Oasis need to be completed to submit a rap?
The OASIS does not need to be completed and locked in order to submit the RAP. You do not need to bill a first billable visit in order to bill a second RAP.
What is the resubmission code for a corrected claim for Medicare?
7Complete box 22 (Resubmission Code) to include a 7 (the "Replace" billing code) to notify us of a corrected or replacement claim, or insert an 8 (the “Void” billing code) to let us know you are voiding a previously submitted claim.
How do I correct my Medicare application?
Users may still request a correction via phone and/or e-mail if the enrollment application is currently being processed by a Medicare contractor. The new information, however, cannot be given and accepted via phone or e-mail. It must still be submitted through Internet-based PECOS.
How do you correct a claim?
Make Changes, Add Reference/Resubmission Numbers, and Then Resubmit: To resolve a claim problem, typically you will edit the charges or the patient record, add the payer claim control number, and then resubmit or “rebatch” the claim.
How do I correct a rejected Medicare claim?
When a claim is denied because the information submitted was incorrect, often the claim can be reopened using a Clerical Error Reopening (CER). CERs can be used to fix errors resulting from human or mechanical errors on the part of the party or the contractor.
Under what circumstances should a corrected claim be submitted?
A corrected claim should only be submitted for a claim that has already paid, was applied to the patient's deductible/copayment or was denied by the Plan, or for which you need to correct information on the original submission.
What is considered a corrected claim?
What is a corrected claim? A corrected claim is a replacement of a previously submitted claim (e.g., changes or corrections to charges, clinical or procedure codes, dates of service, member information, etc.). A corrected claim is not an inquiry or appeal.
How often do you need to submit a RAP?
Then, you submit a claim using TOB 329 for each 30-day POC. The TOB 329 processes as an adjustment to the TOB 322. In the last 2 years, Medicare has been phasing out RAP payments. Starting January 1, 2022, Medicare will require to submit a one-time NO A, instead of RAPs.
When will Medicare update Chapter 10?
This Article tells you about updates to Chapter 10 of the Medicare Claims Processing Manual to include instructions for submitting Home Health (HH) NOAs instead of RAPs on and after January 1, 2022. Please make sure your billing staff is aware of these manual updates.
What is a CGS in Medicare?
CGS Note: It is the responsibility of Medicare providers to ensure the information submitted on your billing transactions (Requests for Anticipated Payment (RAPs), Notices of Election (NOEs), claims, adjustments, and cancels) are correct, and according to Medicare regulations . CGS is required by the Centers for Medicare & Medicaid Services (CMS) to monitor claim submission errors through data analysis, and action may be taken when providers exhibit a pattern of submitting claims inappropriately, incorrectly or erroneously. Providers should be aware that a referral to the Office of Inspector General (OIG) may be made for Medicare fraud or abuse when a pattern of submitting claims inappropriately, incorrectly, or erroneously is identified.
How to add revenue code to FISS?
To add a revenue code line, key the new revenue code line under the 0001 line, and then press the HOME key on your keyboard so that your cursor is placed in the “Page” field (in the upper left hand corner of the screen). Press Enter. You do not need to re-key the revenue codes that were already entered. FISS will automatically reorder the revenue code line that you added. If the claim’s total charges are changing due to the addition of revenue codes lines, update the total charge amount on the 0001 revenue code line to reflect the correct amount.
Can you adjust a claim after it has been processed?
At times, you may need to adjust a claim after it has been processed to make changes (e.g., add or remove services). Claim adjustments can be made to paid or rejected claims (i.e., status/location P B9997 or R B9997). However, adjustments cannot be made to:
What is a rap in Medicare?
The RAP also serves a greater operational role for the Medicare program by establishing the beneficiary's primary HHA in the Common Working File (CWF), so that the claims processing system can reject claims from providers or suppliers, other than the primary HHA, for the services and items subject to consolidated billing.
When is the RAP code needed for 2021?
For “From” dates on or after January 1, 2021, the RAP may contain any valid diagnosis code, in order to facilitate timely submission. Since these RAPs aren’t paid, the accurate principal diagnosis code that supports payment is needed only on the claim for the period of care.
How long does Medicare have to change the unit of payment?
Section 1895(b)(2) of the Social Security Act (the Act), as amended by Section 51001(a) of the Bipartisan Budget Act of 2018 (BBA of 2018), requires Medicare to change the unit of payment under the Home Health Prospective Payment System (HH PPS) from 60 days to 30 days.
What is appeal of Medicare determinations made on HH PPS claims?
HH PPS RAPs do not have appeal rights; rather, appeals rights are tied to the claims that represent all services delivered for the entire episode unit of payment .
What is the output item in a HIPPS claim?
Output item: The HIPPS code used by the Pricer to determine the payment amount on the claim. This code will match the input code in all cases except when the therapy threshold for the claim was not met.
What line is HHA on FL 50?
Required - The HHA enters the six position alphanumeric “number” assigned by Medicare. It must be entered on the same line (A, B, or C) as “Medicare” in FL 50.
When should a HHA submit MSA code?
For episodes in which the beneficiary’s site of service changes from one MSA to another within the episode period, HHAs should submit the MSA code corresponding to the site of service at the end of the episode on the claim.
Does HHA report units of service?
The HHA should not report units of service on 0023 revenue code lines. For line items detailing all services within the episode period, the HHA reports units of service as appropriate to that revenue code. Coding detail for each revenue code under HH PPS is defined above under FL 43. For the revenue codes that represent home health visits (042X, 043X, 044X, 055X, 056X, and 057X), the HHA reports as units of service a number of fifteen minute increments that comprise the time spent treating the beneficiary. Time spent completing the OASIS assessment in the home as part of an otherwise covered and billable visit and time spent updating medical records in the home as part of such a visit may also be reported. Visits of any length are to be reported, rounding the time to the nearest 15-minute increment. Visits cannot be split into multiple lines. Report covered and noncovered increments of the same visit on the same line.
Does HHA need to enter ICd 9?
Required - The HHA enters the full ICD-9-CM codes for up to eight additional conditions if they coexisted at the time of the establishment of the plan of care . None of these other diagnoses may duplicate the principal diagnosis listed in FL 67 as an additional or secondary diagnosis.
Does the HHA have to enter the ICD-9 code for additional conditions?
Required - The HHA enters the full ICD-9-CM codes for up to eight additional conditions if they coexisted at the time of the establishment of the plan of care. These codes may not duplicate the principal diagnosis listed in FL 67 as an additional or secondary diagnosis.
