Medicare Compliance & Reimbursement

CMS to take it easier on RAP recoupments, pending M0175 takebacks.

The 91 home health agencies the Centers for Medicare and Medicaid Services estimates are affected by Hurricane Katrina soon will gain some reimbursement breathing room.

Normally, home health agencies must submit their final claim either 60 days from the end of the patient's episode or 60 days from the issuance of the request for anticipated payment. If they don't meet either of those 60-day deadlines, the regional home health intermediary recoups the RAP amount.

But HHAs affected by Katrina will receive a blanket extension of the 60-day timeline for the final claim, CMS said in a recent Open Door Forum for home care providers. Forthcoming instructions will apply the extension to disaster-affected regions, CMS' Wil Gehne told the forum's 250-plus callers.

"RAPs for HHAs in the disaster affected areas will be assigned cancellation dates of Jan. 3, 2006," explains Gehne. That will allow agencies an additional 60 to 90 days to resume submission of final claims. CMS has sent the instructions to its contractors and should post that information in the Katrina questions and answers soon, Gehne says.

Agencies will also see more limited relief for the M0175 takebacks that are set to begin in November. The recoupments are for episodes in which HHAs incorrectly marked prior inpatient stays during the first years of the prospective payment system.

Individual providers affected by the disaster can request relief from their RHHIs on the M0175 recoupments, Gehne told the forum.