Our last blog detailed the very real threat that agencies face in having their RAP payment suppressed for cancelling too many RAPs.
There are plenty of steps that agencies can take to prevent CMS from suppressing their RAP payments. To ensure they don’t cancel too many RAPs, and to keep reimbursements steady, agencies should follow these steps:
- Know the timelines for submitting final claims. The timeline for filing is the greater of these two:
- 120 days after start of the episode
- 60 days after paid date of RAP
- On the Remittance Advice, keep track of cancelled claims (either type 328 or 338)
- Use Direct Data Entry (DDE) and Online Provider Services (OPS) to monitor status of RAPs and final claims in real time
- Monitor outstanding RAPs to ensure the final claim is submitted on time
Because CMS tracks the percentage of cancelled RAPs to determine RAP suppressions, use the formula below to track your rates. If you are working your way out of suppression, this formula can also help track your improvement over time.
(# of Cancelled Claims / # of Final Claims Submitted) x 100
Here are a few examples:
Example One:
June 1 to June 30
Total RAPs cancelled = 5
Total FINALS processed = 25
RAP Cancellation Rate = 20%
Example Two:
July 1 to July 31
Total RAPs cancelled = 15
Total FINALS processed = 25
RAP Cancellation Rate = 60%
Revenue management is crucial for agency survival. The threat of zero payment RAPs is real, and action should be taken immediately. Billing managers and administrators need to closely monitor the submission of RAPs and final claims.
By following these simple measures, agencies can put policies in place to ensure revenue is available to care for the deserving Medicare beneficiaries when needs arise. More information can be found on billing policies from Palmetto GBA here and from CMS here.
There are a lot of moving parts in billing, and the reality is that agencies could go out of business without properly managing their billing processes. If your agency can’t keep up, consider using billing services such as AxxessBilling to relieve the stress on your agency.