Home Health & Hospice Week

CBSA code, line-item date edits gum up RAP submissions.

Along with no-pay Requests for Anticipated Payment have come claims system snafus. Keep tabs on the issues so they don’t trip up your billing.

In addition to a problem in penalty imposition for early filing (see story, p. 34), the Centers for Medicare & Medicaid Services has outlined two no-pay RAP billing problems:

Problem No. 1: RAPs were returning incorrectly when value code 61 was not present for dates of service on or after Jan. 1, 2021. The error is indicated by Reason Code 32035, a CMS official said in the Jan. 26 Home Health Open Door Forum. “Reporting a CBSA code using value code 61 is optional for 2021 home health RAPs,” HHH Medicare Adminis­trative Contractor Palmetto GBA explained in a post that it has since deleted. “However, Medicare systems are returning RAPs without value code 61 in error.”

The solution: In a workaround implemented by the MACs, they are adding the value code and a “placeholder” CBSA code, the CMS source explained. Home health agencies can “disregard any added codes” and don’t need to take any action, he said. The placeholder CBSA code is 10180, CMS detailed in a message to providers.

Problem No. 2: RAPs are incorrectly getting kicked out if the revenue code 0023 line falls outside the period’s “from-through” dates, the CMS staffer recounted. The problem is indicated with reason code W7216. That edit shouldn’t apply to RAPs, he noted.

The solution: RAPs will bypass this edit going forward without provider action, the CMS source said. If RAPs end up exceeding the five-day deadline, agencies can request a timely filing exception, he added.