Home health agencies face more billing complexities than any other provider type. Agencies must ensure numerous tasks happen smoothly and precisely between the beginning of an episode to the submission of a Request for Anticipated Payment (RAP) through submitting a final claim. With heavy regulation, uncertainties and industry scrutiny, agencies are juggling many rules and extra steps to get paid.
Consistent, clear processes upon patient referral are the essential building blocks of accurate and fast payment. As you know firsthand, starting a new episode includes many steps, like the physician referral and completion of a billable visit. Then the OASIS (Outcome and Assessment Information Set) file must be locked and the plan of care complete.
eSolutions helps your team ensure the beginning of an episode goes off without a hitch, starting with patient eligibility verification. eSolutions eligibility verification tool retrieves real-time information from Medicare and other payers to check your patient’s coverage, including specific home health billing information like prior or overlapping episodes. Our products eliminate duplicate claim issues for billing RAPs.
eSolutions’ OASIS Submission service helps you easily complete and submit the OASIS file. This service automatically picks up files from your network and uploads them to CMS. The system sends your clean OASIS data set to CMS, then returns a validation report. This ensures maximum reimbursement, less time spent on OASIS forms and a secure file trail in case of an audit. Our OASIS Analysis tool provides analytics of your OASIS data set by scrubbing your data for errors and other inconsistencies in the OASIS form.
Once your OASIS file is submitted and locked, the service returns your validation report and you’re ready to produce a RAP-ready, compliant claim.
RAP Billing and Claim Editing
eSolutions’ Medicare Enterprise is second to none for taking on RAP billing, helping you get the right information billed cleanly. Enterprise features web-based claim edits directly in the DDE, saving you from manually fixing claims in the DDE. Claim editing is available 24/7 so you can work when it’s convenient. Additionally, Enterprise allows you to cancel and re-bill a RAP directly in our claims editing system simultaneously, enhancing your team’s productivity.
Every home health agency knows the importance of managing RAPs and preparing for the final claim, but keeping on top of the process and determining the most efficient workflows can be overwhelming. So overwhelming, in fact, that some agencies neglect billing the final claim and take their chances.
But failure to establish proper billing protocol, good workflows and procedures around RAPs can lead to cash flow interruption, takebacks, audits and the dreaded Z-RAP.
While you can’t completely eliminate takebacks, using Medicare Enterprise helps you dramatically reduce them. Enterprise closely tracks RAPs and helps you submit timely final bills. Using the reporting and analytics component of Enterprise, you have access to the most robust reports available: The RAP at Risk and the Cancelled RAP Monitor.
The RAP at Risk is a daily report delivering easy-to-understand claim level detail on all affected claims:
- RAPs at Risk for Auto-cancellation: Alerts you two-weeks before your RAP is auto-cancelled and Medicare takes money back. With this report, you can prioritize which final claims get sent first and avoid restarting the whole billing process.
- RAPs Cancelled Today: Notifies you about RAP takebacks before you see the information on the remittance, allowing you to bill and get paid on a new RAP faster.
- Final Claims in RTP with No Paid RAP
- RAP Claims Paid Today: Compare the RAP Claims Paid Today with the Final Claims in RTP with No Paid RAP tabs to identify if there are any final claims waiting on a paid RAP that can be fixed if there are matching RAPs paid today. Keeping an eye on this comparison with help you accelerate cash flow.
The RAPs at Risk report also offers detailed visibility into your workflow, drilling down layer by layer for the most comprehensive picture into why you’re not getting paid.
Customize your reports by user, workgroup, location, provider, and more so you can pinpoint the exact location of minor hang ups or more serious problems.
The Cancelled RAP Monitor report monitors your cancelled RAP percentage and offers powerful benchmarking. Cancelled RAPs cannot only create interruptions in cash flow attributed to takebacks, with CMS’ Z-RAP policy in full force, providers that don’t keep a handle on cancelled RAP percentages are at risk of not being paid on their RAPs at all. This benchmark allows you to keep an eye on the frequency of cancelled RAPs so you don’t exceed a threshold that could impair cash flow.
Unprecedented regulatory scrutiny faces home health agencies like never before, leading to multiple types of reviews and audits. Auditors will examine your recertification, therapy visits and clinical service utilization to determine if you are following the rules, or if your organization warrants further attention.
RAP takebacks can happen when the final claim is not submitted on time, and the most common cause of late submission is a missing physician signature. Medicare Enterprise has everything home health agencies need for a seamless revenue cycle, including our special Notes feature that allows office staff and clinicians to communicate. Notes alert clinicians of inadequate or absent critical information, like a missing physician signature, so you can avoid takebacks.