Understanding PDGM No-Pay RAP - CMS Guidelines

Home Healthcare Weekly News - Nov 19, 2020

CMS introduced the Patient-Driven Grouping Model (PDGM) payment model for Home Health Prospective Payment System (HH PPS) starting January 1, 2020. Beginning January 1, 2021, home health agencies (HHAs) will be required to submit a Request for Anticipated Payment (RAP) before filing each claim. CMS will pay the RAP at 0 percent. The Centers for Medicare & Medicaid Services (CMS) finalized the No-pay RAP policy in the CY 2020 Home Health Prospective Payment System Rate Update rule.

Although there is no payment assigned to the RAP, it still serves an operational role for the Medicare program by establishing the beneficiary’s primary home health agency (HHA) in the Common Working File (CWF) to enforce the consolidated billing rules. CMS has modified the criteria for submitting RAP beginning January 1, 2021.

CareVoyant will be implementing software enhancements to accommodate No-Pay RAP to help Home Healthcare Agencies effectively manage No-Pay RAP. 

Also, read our blog titled Home Health Care Agencies: Are you ready for PDGM?, for more information on PDGM readiness for home healthcare agencies.

With falling reimbursement rates, the rollout of PDGM, and increased compliance, Home Care Agencies are under pressure to do more with less. Improving the health of the revenue cycle is a complex process that needs caregivers and financial administrator to work in synchrony to achieve optimal results. An integrated platform that covers all processes including intake, authorization management, scheduling, billing, and collections, and provides features to manage the revenue cycle requirements of these processes is a must for ensuring optimal reimbursements.

Scheduling home care visits presents a unique challenge to home care agencies. Achieving the right solution can be a daunting task and requires a careful balancing of many variables – from matching the right caregiver to the right patient, to travel time optimization, to client preferences, to balancing overtime pay and more.

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About CareVoyant

CareVoyant is a leading provider of cloud-based integrated enterprise-scale home health care software that can support all home-based services under ONE Software, ONE Patient, and ONE Employee, making it a Single System of Record.  We support all home care lines of service, including Home CarePrivate Duty NursingPrivate Duty Non-MedicalHome and Community Based Services (HCBS)Home HealthPediatric Home Care, and Outpatient Therapy.

CareVoyant functions – Intake, Scheduling, Clinical with Mobile options, electronic visit verification, eMAR/eTAR, Financial, Secure Messaging, Notification, Reporting, and Dashboards – streamline workflow, meet regulatory requirements, improve quality of care, optimize reimbursement, and bring operational efficiency.

For more information, please visit CareVoyant.com or call us at 1-888-463-6797.


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