Home Health & Hospice

Insider’s scoop | Understand RAP requirements

Homecare Insider, June 13, 2016

Editor’s note: This week’s Insider’s scoop is from The How-To Guide to Home Health Billing, Second Edition. Accurate, compliant practices are a must to ensure you receive the payment you’ve earned. This second edition updates many critical elements involved in billing, enabling your agency to provide the best training possible to billing professionals and other staff. Click here for more information.

There are many types of payment under the Medicare prospective payment system (PPS) benefit. The request for anticipated payment (RAP) is the first payment received. The HHA may submit a request for the initial anticipated payment based on receiving verbal orders from the physician and delivering at least one service to the patient. The RAP pays 60% of the episode’s worth for the initial episode and 50% of the episode’s worth for all subsequent episodes.

The HHA can submit a RAP to Medicare when all of the following conditions are met:

  • After the OASIS assessment is complete, locked or export ready, or there is an agencywide internal policy establishing the OASIS data is finalized for transmission to the state;
  • Once a physician’s verbal orders for home care have been received and documented;
  • A plan of care has been established and sent to the physician; and
  • The first service visit under that plan has been delivered.

RAPs may be paid 0% if Medicare is the secondary payer or if the patient is enrolled in a Medicare Advantage program.