I am constantly surprised at how many agencies authorize RAP after RAP (Request for Advance Payment) and seem to forget about the final claim. It’s great to get that advance payment and use it as Medicare intended...to keep your agency humming along until the final payment is received. One must remember that a RAP payment is - essentially - just a loan to keep you afloat until the certification period is over. home health billing
The Final Claim should be submitted not more than 60 days after the RAP is paid. Failure to submit a Final Claim in a timely fashion (especially when it is the agency’s habitual procedure) is very annoying to Medicare and causes them to go over each submission with a fine-tooth comb and make the payment of finals claims a lengthy, time-consuming affair.
Many times, only the assessment and perhaps one or two more visits take place and the RAP has already been submitted and/or paid. Why go to the trouble of submitting a Final or LUPA? A couple of hundred dollars is better than nothing, and it keeps Medicare happy in that the case is closed.
When the 60 day period following the RAP payment lapses and no Final has been submitted, the RAP expires and Medicare takes its loan back from your Medicare fund - if there’s any money left in it - or against future funds you may have coming in. You can, of course, resubmit the RAP, but doing so time after time is also annoying to Medicare.
Get Physician Orders Signed and Visits Logged into EMR
It is a good practice to start thinking about the Final Claim as soon as the patient’s visit schedule is established. The cause of delays in final claim processing times, in most cases, is the lack of the physician’s signature for treatment orders. Another essential practice is to get all visits entered into your EMR as they occur, instead of waiting until the certification period is over when visits may be overlooked and left out. It is almost impossible to try to change a Final already submitted to Medicare to add visits. This requires cancellation of the paid RAP and re-submission of both RAP and Final.
For RAPs, a huge advance payment may be great when you receive it, but remember that Medicare is only going to pay for what services it deems necessary when the Final Claim is submitted, and if the RAP is bloated, money will again be taken back. So it is wise to be realistic about the patient’s condition and treatment.
Keeping Medicare happy (seeing that you are submitting complete claims in a timely and consistent manner) will ensure speedy reimbursement.