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:
- The appropriate physician’s written or verbal order has been received and documented as required. And
- 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.