Failure to submit a Final 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.
It is a good practice to start thinking about the Final as soon as the patient’s visit schedule is established. What delays final claims processing times, in most cases, is the lack of the physician’s signature for orders and I realize that it is a pain in the neck, chasing the MD down for this. Another essential practice is to get all visits entered into MHCB as they occur, instead of waiting until the cert 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 resubmission of both RAP and Final.
Another thing about 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 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.