Home Health & Hospice Week

MAC offers pre-billing tool to avoid returned claims.

If you’re not careful, some missteps with submitting Requests for Anticipated Payment could turn into an unpleasant cash flow drain.

Problem #1: “Certain billing elements on the final claim must match a processed Request for Anticipated Payment (RAP). When the information does not match, the final claim will be sent to the Return to Provider (RTP) file with reason code 38107,” HHH Medicare Administrative Contractor CGS reminded home health agencies in its July Medicare Bulletin.

The elements that must match, the MAC explains, are the National Provider Identifier number; “FROM” date; “ADMIT” date; first four positions of the Health Insurance Prospective Payment System (HIPPS) code; and service date on the 0023 revenue code line (the first Medicare billable service date).

Solution #1: “Before submitting your final claim, check FISS to ensure there is a matching RAP for your claim,” CGS advises. To view a table that the MAC suggests agencies use to cross check final claims with RAPs, as well as screen shots of how to check the claims system for a matching RAP, go to https://cgs medicare.com/hhh/pubs/mb_hhh/2017/j15_hhh_07-17.pdf.

Problem #2: Home health Medicare Secondary Payer RAPs are being rejected with reason codes U6815, U6816, U6817, and U6818 in error, MAC Palmetto GBA says on its website. RAPs “are being rejected when an MSP record exists on the Common Working File (CWF) instead of processing with a ‘Z’ (zero payment indicator),” the MAC explains. Because the RAPs are rejected, the final claims also are rejected.

Solution #2: HHAs can sit tight until a fix for the problem is implemented Oct. 2, Palmetto says. Or “for final claims that will not process due to the RAP being rejected, providers may request that the RAP be attached to the final claim by contacting the Provider Contact Center,” Palmetto instructs. Stay tuned for directions on resolving the issue after the fix is in place, the MAC adds.