No pay RAPs.

Most home cares will not be sending both 1^st and 2^nd 30 day RAPs at the same time for various reasons such as trying to capture correct revenue to whether or not we have a plan of care that spans beyond the first 30 day period.

The 5 days window for RAPs was clarified as the start of care day is day zero then count to five from there. Be mindful not to allow staff to get used to the idea they have extra day to get charting done.

Even if it is anticipated a billing period will be a LUPA, it is best practice to send a no pay RPA just in case the number of visits in the billing period goes beyond LUPA.

It is advised for biller to shoot for billing RPAs by day 3 in case the RAP gets held up or RTP’d. Good idea to check with claim venders to make sure they are set up to make sure RAPS go through as quickly as possible to Medicare.

There are no answers from any of the advantage plans on whether they will follow the no pay RAP like Medicare or not. Aetna representative did tell me they will likely follow Medicare’s methods very closely. Billers can either try calling the plans in January before billing to see if there are any new answers or try billing. WE will have to share our successes/failures on the list serve J

One participants said they watched a webinar which explained how Medicare pays off the oasis where the advantage plans pay off the claim HIPPs code so for advantage plans, we will NOT want to use the generic HIPPS code. This will make these plan member’s no pay RAPs very important to keep staff on top of getting oasis done.

Participant asked why advantage plans don’t always pay according to the projected payment and what to do for appealing these. My issue I brought up was we don’t always know if it is because of the contract we have so it is good to check with who ever does the contracts with payers. This is a difficult thing to do if part of a large scale health care system.

The Optum VA site is not on some want to use because the sign up asks personal questions of employees who do not feel comfortable answering them for a work related website access. It is basically trying to make sure they are not giving access to someone who really shouldn’t have it. Once signed up, the site is very user friendly.

Feel free to reach to those who share your software to discuss ways to trouble shoot the changes coming up.

We will not be able to have a meeting in January as we will most likely all be very busy trying to work with all the changes as well as the new year turn over we all go through, but the biller list serve group is always there for help!

Stay tuned for a February zoom meeting date and time!

Happy Holidays everyone!!!! Stay safe and healthy!

Tracy Salin

Billing Specialist

Fairview Range Home Care and Hospice

Phone: 218-262-6982

Fax: 218-262-1723