Tag: RAP

CMS Issues Corrections to Claims Processing Policy and 60 Day Calculation Inconsistency

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12657, removing the requirement to submit a Notice of Admission (NOA) before billing for home health denial notices. The CR also revises home health edit criteria to ensure Medicare systems calculate 60-day gaps in service consistently. CMS’ long-standing policy to exclude billings…

CMS Revises Manual Instructions for the NOA and Allowed Practitioners

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request (CR) 12615 that incorporates policies for the implementation of the  Notice of Admission (NOA) and the subsequent elimination of the Request for Anticipated Payment (RAP). The NOA became effective January 1, 2022. The CR also provides corrections and clarifications regarding who may sign…

CMS Provides Quality Reporting and Other Updates in Most Recent Open Door Forum

This article covers only the hospice portion of the most recent CMS Open Door Forum. To read about the home health portion, please see this NAHC Report article.

During the most recent Centers for Medicare & Medicaid Services (CMS) Home Health, Hospice, and DME (Durable Medicare Equipment) Open Door Forum (ODF), the following information and updates were provided.

CMS reminded hospices that the FY2024 annual payment update is based on the CY2022 data submissions.  Hospices must comply with the following HIS and Hospice CAHPS Survey participation requirements to avoid the APU penalty which increases to 4% in FY2024.

  • Submit at least 90% of HIS records within the 30 days of the event date (patient’s admission or discharge) for patient admissions/discharges occurring 1/1/22 – 12/31/22
  • Ongoing monthly participation in the CAHPS Hospice Survey 1/1/22 – 12/31/22

The February 2022 quarterly refresh for the Hospice Quality Reporting Program is now available on Care Compare. Public reporting of quality measure data has resumed following the temporary exemption to HQRP data submission requirements, and the subsequent data freeze after the November 2020 refresh. Consumer Assessment of Healthcare Providers and Systems (CAHPS) Hospice Survey measure scores continue to exclude Quarter 1 and Quarter 2 of calendar year 2020.

In December 2021 CMS released revised data for the Hospice Care Index (HCI) in the hospice level Quality Measure (QM) reports available to hospices in their CASPER folder.  CMS identified an issue with the national averages calculations and corrected these in the reports.

CMS is targeting the Care Compare refresh in May 2022 for public display of the HCI and Hospice Visits in Last Days of Life (HVLDL) claims-based measures.

Hospices can access resources available to them regarding the Hospice Quality Reporting Program (HQRP) here.

CMS Provides Quality Reporting and Other Updates in Most Recent Open Door Forum

During the most recent Centers for Medicare & Medicaid Services (CMS) Home Health, Hospice, and DME (Durable Medicare Equipment) Open Door Forum (ODF), the following information and updates were provided. HOME HEALTH Home Health Claims Processing Issues Notice of Admission                            CMS officials reported on  a claims processing issue where the NOA is returning to providers…

CMS Open Door Forum: Updates to Home Health Quality Reporting Program & More

On April13, 2021 The Centers for Medicare & Medicaid Services (CMS) held the Home Health, Hospice, and Durable Medical Equipment Open Door Forum. The majority of information shared with the participants pertained to hospice providers. However, several issues impacting home health agencies were also discussed. Home Health Quality Reporting Program (HHQRP) CMS announce that five…

CMS Revises HHA Claim Instructions

The Centers for Medicare & Medicaid Services (CMS) has issued corrections to Change Request 11855 through Transmittal 10696, dated, March 31,2021. The revisions include instructions that any principle diagnosis may be reported on the request for anticipated payment (RAP) in order to facilitate timely submission. Since these RAPs are not paid, the accurate principal diagnosis…

CMS Open Door Forum Addresses HIT, Home Health CAHPS and Claims Processing Issues

The January 26, 2021 the Centers for Medicare & Medicaid Services (CMS) held a Home Health, Hospice, and DME (Durable Medical Equipment) Open Door Forum addressed several issues of interest to home health providers. A summary of the issues pertaining to home health are below. (Matters of interest for hospice providers were covered earlier this week…

CMS Issues a Workaround for RAPs Without Value Code 61

Home health agencies (HHAs) have had requests for anticipated payments (RAPs) retuned to providers (RTP’d) related to value code 61. With the no pay RAP policy, effective January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is no longer requiring that HHAs report value code 61 and the core-based statistical area (CBSA) on…

Recommendations and Clarifications for HHAs on the No-Pay RAP

Beginning January 1, 2021, home health agencies (HHAs) will be required to submit a request for anticipated payment (RAP) that will be paid at 0 percent, prior to each claim. The Centers for Medicare & Medicaid Services (CMS) finalized the No-pay RAP policy in the CY 2020 Home Health Prospective Payment System Rate Update rule.…

CMS Provides Instructions for Submitting No Pay RAP

The Centers for Medicare & Medicaid Services (CMS) released Transmittal 10254/Change Request (CR) 11855 Penalty for Delayed Request for Anticipated Payment (RAP) Submission – Implementation on July 31, 2020. The CR updates Chapters 3 and 10 of the Medicare Claims Processing Manual with instructions to Medicare Administrative Contractors (MACs) and providers for the generation and…