Home Health & Hospice Week
Don't Let RAP Time-Outs Affect Your Cash Flow
You also need to be sure these fields match. Almost one-quarter of claim submission errors in March were due to final claims lacking a matching Request for Anticipated Payment, reports one HHH Medicare Administrative Contractor. “When a final claim is submitted to Medicare, [the Fiscal Intermediary Shared System] will search for a matching RAP,” says MAC CGS in its May provider bulletin. “FISS will send the final claim to the return to provider (RTP) file (status/location T B9997) with reason code 38107 when a matching RAP is not found, or when one or more … fields does not match between the RAP and the final claim.” The fields that must match are: billing provider’s NPI (UB-04 Form Locator 60); STMT DATES FROM (UB-04 FL 6); ADMIT DATE (UB- 04 FL 12); HCPC (UB-04 FL 44); and SERV DATE (UB-04 FL 45). Tip #1: The “STMT DATES FROM” field should list the date of first Medicare billable visit in the episode for Start of Care episodes, or the first calendar day of the episode for recertification (subsequent) episodes, CGS offers in the article. Tip #2: For the “HCPC” field, “FISS compares the first four positions of the HIPPS code between the RAP and final claim for the same episode of care,” CGS explains. “March analysis of claim submission errors (CSEs) showed that 38107 accounted for 23 percent of all CSEs received by HHAs who bill to CGS,” the MAC says. See more information in the bulletin at www.cgsmedicare.com/hhh/pubs/mb_hhh/2017/j15_hhh_05-17.pdf.
Home Health & Hospice Week
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Don't Let RAP Time-Outs Affect Your Cash Flow
You also need to be sure these fields match. Almost one-quarter of claim submission errors [...] - Industry Note:
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