RESOLVED: Home Health: Payment on Claims When the Requests for Anticipated Payment Were Submitted More than 30 Days Late

Resolved: Home Health: Payment on Claims When the Requests for Anticipated Payment (RAP) Were Submitted More than 30 Days Late

Current Status

Date

Status: The fix to this issue is scheduled to be released in the of July 6, 2021, HH Pricier update. Claims received on or after July 6, 2021, should process correctly and not pay if the RAP was received more than 30 days late and an exception for the late RAP was not requested or approved. 

Provider Action: Once the fix is implemented, HHAs will need to adjust their claims to receive correct reimbursement and return any overpayments. HHAs should use the “D9” condition code on their adjustments and add remarks stating, “Adjusting due to CPIL issue claim paid and RAP was more than 30 days late” If an HHA meets a late RAP exception requirement, they may submit the adjustment following the exception process. 

Open

4/7/2021

Status: This issue has been reported and is in research.

Provider Action: HHAs should submit RAPs and claims as normal. We will provide updates when available.

Issue Description

For 2021, there is a non-timely submission payment reduction when the HHA does not submit the Requests for Anticipated Payments (RAPs) within 5 calendar days from the “from date” on the claim. This reduction in payment is equal to a 1/30th reduction to the payment amount for each day from the period “from date”, until the date the HHA submits the RAP.

Therefore, if a RAP is submitted later than the “through date” on the corresponding claim, no payment should be made. We have identified claims that are receiving payment when the RAP submission date is later than the “through" date.