Version 6889 dated 05/11/2021 is  available.

Version 6883 will include an update to the Home Health Aide Plan of Care.

An Additional tab has been added labeled Frequency/Supervisory. This will include the Visit Frequency/Duration and Supervisory Visit Frequency. When filled out, these will print in the lower right hand area of the HHA POC printout. If nothing is added in these fields, then it will display as a blank box on the HHA POC.

Clinical Software Version Update 2906 dated 04/27/2021 is  available.

A new PECOS File is available for download as of 04/19/2021

There appears to be an issue with logging into the Allegheny Software Managed Hosting Software from within different web browsers. Our technical staff is actively working on this.

3/12/21 4:30p- Issue resolved. Log in Screen may appear different at this time, but Allegheny Software Logo still appears on the top of the log in screen.  Current User Name and Password remains unchanged.

On 2/22/21, CMS Claims Processing Issues has announced update regarding Reason Codes U5391 & 38107: No RAP or No Matching RAP is found. After they researched the issues, the CMS system is editing claims correctly. They report that regardless of when the RAP is submitted, the 0023 revenue code date submitted on the RAP and the claim MUST MATCH.

We have made an update to HHC 3000, that will accommodate this change. The update will be available 2/23/2021, Version 6836.

When billing a subsequent RAP, if the First Billable visit field is left blank, the software will use the ‘From’ date of the billing period on the RAP Claim. This will post the billing period ‘From’ Date into the 1st billable visit field for FINAL billing. Agencies will NOT want to use the ‘wrench’ button to automatically pull in the first billable visit, as then the 0023 line date will not match for RAP & Final Claim, if the RAP was billed with a ‘From’ date.

Please contact Allegheny Support with any additional questions.

Version 6816, dated 1/22/2021 includes an update to the PDGM billing screen.

When viewing the PDGM Billing screen, the user will see a ‘RAPs Only’ button in the top right corner. When the user selects this button, it will display only the RAPs instead of both the RAPs & Finals.

The user will be able to view the following information:

  • Date (Date the assessment was completed)
  • Insurance Company
  • Patient Name
  • Type of Document
  • RAP Start (“From” date of the billing period)
  • Date Billed
  • Days N/B (Days Not billed)
  • RAP Button for billing
  • Days Till (Days until 2nd billing period)
  • RAP2 Start (“From” date of 2nd billing period)
  • Billed Date
  • Days N/B
  • RAP2 Button for billing

This will allow agencies to review their RAPs easier for timely billing.

When the user is wanting to return to the RAP/FINAL page, they would select the ‘RAP/Finals’ button in the same spot and it will return the user to the PDGM Billing screen.

Main software version  update 6796, dated 1/6/2021, includes an ICD-10 code update that is effective 1/1/2021.

Also, the version update includes the ability to add the KX modifier to a PDGM claim. CMS has stated that “If a 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. HHAs should resubmit corrected RAPs promptly (generally within 2 business days of canceling the original RAP).”

On the PDGM Screen/ Oasis Billing Info Screen, you will now see a KX Modifier checkbox, that will need to be selected, if a claim requires it.

Reminder for Medicare Providers: All periods of care with “From” dates on or after 1/1/2021, RAPs must be submitted and accepted within 5 days.  **This would include 2nd 30-day billing periods.**

Medicare no longer makes payment on RAPs, though RAP submission is still required for periods of care. RAPs with ‘From” dates on or after 1/1/2021 will no longer be automatically canceled because there will be no payment to recoup.

Per the Medicare Claims Processing Manual, A timely-filed RAP is submitted to the A/B MAC (HHH) and accepted by the A/B MAC (HHH) within 5 calendar days after the “From” date of a HH period of care (30 day billing period). While a timely-filed RAP is submitted to and accepted by the Medicare contractor A/B MAC (HHH) within 5 calendar days after the “From” date, posting to the CWF may not occur within that same time frame. The date of posting to the CWF is not a reflection of whether the RAP is considered timely-filed. In instances where a RAP is not timely-filed, Medicare shall reduce the payment for a period of care, including outlier payment, by the number of days from the home health “From” date to the date the RAP is submitted to, and accepted by, the A/B MAC (HHH), divided by 30. No LUPA per-visit payments shall be made for visits that occurred on days that fall within the period of care prior to the submission of the RAP. This reduction shall be a provider liability, and the provider shall not bill the beneficiary for it.

If an HHA fails to file a timely-filed RAP, it may request an exception which, if approved, waives the consequences of late filing. The four circumstances that may qualify the HHA for an exception to the consequences of filing the RAP more than 5 calendar days after the HH period of care From date are as follows:

1. fires, floods, earthquakes, or other unusual events that inflict extensive damage to the HHA’s ability to operate;

2. an event that produces a data filing problem due to a CMS or A/B MAC (HHH) systems issue that is beyond the control of the HHA;

3. a newly Medicare-certified HHA that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its A/B MAC (HHH); or,

4. other circumstances determined by the A/B MAC (HHH) or CMS to be beyond the control of the HHA.

**A new report is available to users for tracking of Non-billed RAPS. Billing/PDGM Reports/PDGM Billing Status Report & run Including “Including Only RAPs Not Billed”.  This Report will display all RAPs not billed and the amount of days that have passed since the “from” date of the billing period.

2021 Home Health Regulatory Changes found in update 6789 dated 12/30/2020.

Starting 1/1/2021, agencies that bill Medicare will now be required to submit the RAP within 5 days from the Start of Care. The split-percentage payment will be lowered to 0 percent for all HHAs.

All HHAs will still be required to submit a RAP at the beginning of each 30-day period.

RAPs can be submitted when:

  1. The appropriate physician’s written or verbal order has been received and documented as required. And
  2. The initial visit has been made within the 60-day certification period.

In instances where the POC dictates multiple 30-day periods of care, the HHAs are now allowed to submit the RAPs for both the 1st & 2nd 30-day periods at the same time.

CMS has announced that there will be a non-timely submission payment reduction when a HHA does not submit the RAP within 5 calendar days from the SOC date for the 1st 30-days period of care in a 60-day certification period and within 5 calendar days of the “from date” for the second 30-day period of care in the 60-day certification period. This reduction in payment will be equal to a 1/30th reduction to the wage and case-mix adjusted 30-day period payment amount for each day from the HH start of care date/admission date, or “from date” for subsequent 30-day periods, until the date the HHA submits the RAP.

CMs has announced that you can now bill the RAP with a generic HIPPS code to ensure you get it submitted and accepted within the 5 day window. The Main software will now have the ability to add a generic HIPPS code to the RAP & Final claim. Within PDGM Billing/OASIS Billing Info screen, there will be an override, “Bill generic HIPPS” within each 30-day period billing areas. This will enter a generic HIPPS code on the RAP claim. If this is selected, agencies CANNOT remove the checkmark unless they have cancelled their RAP and resubmitted a new RAP without a generic HIPPS code on it. The HIPPS code on the RAP & the Final MUST match.

Accounts Receivable will still be updated on RAP billing as it always has. If an agency chooses to bill with a generic HIPPS code, A/R will reflect that generic HIPPS code amount, but when the FINAL is billed, A/R will show an adjustment to the correct amount generated by the accurate HIPPS code calculated.

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