Home Health & Hospice Week

Add one more HHA issue to the approved list of RAC audit topics. Recovery Audit Contractor Connolly Healthcare recently posted "RAP claim without corresponding home health claim" as an approved audit issue. Connolly is the RAC for Region C covering Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Puerto Rico.

The topic is interesting, because the Medicare claims system is supposed to automatically recoup a RAP payment when the agency fails to submit a final claim within 60 days of the RAP payment. But apparently the system isn't always doing that. "After data research of Medicare claims database, RAP claims were identified without a corresponding home health final claim," Connolly says on its website.

CMS doesn't believe the RAP problem is widespread, the National Association for Home Care & Hospice reports.

This topic joins one other approved issue for home health at Connolly. In January, the RAC posted a home health topic, "Incorrect billing of Home Health Partial Episode Payment claims." But under this topic, HHAs who billed incorrectly would actually receive a repayment for the error.

Connolly receives 9 percent of adjustments, whether they are over- or underpayments. The RAC has the lowest contingency fee rate, with the highest being Region B RAC CGI Technologies and Solutions at 12.5 percent.