Home Health & Hospice Week

You’ll no longer receive RAP payments from fee-for-service Medicare for Medicare Ad-vantage patients starting Jan. 1.

The problem: Current Medicare systems edits prevent claims from receiving payment when the dates for a home health episode fall entirely within an MA enrollment period, CMS says in MLN Matters article MM8710. "However, RAPs for such episodes are currently being paid," CMS notes. "Since these RAP payments will be recovered in full when the final claim is received and rejected or when no final claim is received after 120 days, the RAP payments create an avoidable ‘pay and chase’ situation."

The solution: Starting Jan. 1, 2015, the Medicare system will change to "ensure that RAPs with ‘From’ dates falling within Medicare Advan-tage enrollment periods are processed but are paid at zero percent," CMS explains. "This will allow the final claim to be received and rejected appropriately, but will prevent any program vulnerability."

RAPs will be rejected when the RAP contains a payment amount greater than zero, and the RAP ‘From’ date falls on or after the start date and before the end date of a MA enrollment period, CMS says in the article.

Plus: You should be able to distinguish between Medicare Advantage-related zero-paid RAPs and zero-paid RAPs processed in Medicare Secondary Payer (MSP) situations by looking for Remittance Advice Remarks Code N360: "Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim."

The MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM8710.pdf.