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A bad RAP

Home health agencies struggle to avoid auto-cancellations

Tammy Worth, Contributor

When Palmetto GBA, the country’s largest home health and hospice Medicare administrative contractor, announced last year it planned to suppress payments to home health agencies identified as having a high number of auto-cancelled requests for anticipated payment, Palmetto’s decision forced many in the home healthcare industry to increase their efforts to track and send claims in the time frame allotted.

After sending out a RAP and receiving some payment, home healthcare agencies have 60 days to submit an end of episode claim to receive the remainder of the payment. If that end of episode claim is not received in time, the Centers for Medicare & Medicaid Services auto-cancels and the whole process has to restart, resulting in lack of payment for home healthcare agencies and a lot of hassles for everyone.

But many home healthcare providers find it difficult to keep track of their RAPs, said Bud Meadows, executive vice president of the healthcare technology company ABILITY, which offers a product for RAP tracking.

For one thing, the majority of home healthcare agencies are small, meaning they have less than $2 million in annual revenue. Lacking financial leverage, many aren’t using the technologies available to track RAPs; a good number, he said, often track the RAP process with “sticky notes.”

Family Home Health Services, which has 11 offices throughout Florida, used to track part of its RAP process using an Excel spreadsheet, said Stacy Patton, billing manager for the organization. “It was difficult to manage,” she said, because staffers would get busy and forget to put information in the spreadsheet.

Family Home Health Services primarily relies on its old billing system to help keep track of RAPs. But that is problematic.

One of the biggest holes in using the old billing system is that it isn’t suited to tracking where RAP-related orders are, Patton said. Signed doctors’ orders are required with the end of episode claim. In order to get signed orders, they’ve created a system wherein they fax orders to doctor’s offices – multiple times if necessary. If the multiple faxes don’t result in a signed order, they send an account executive to the office.

While this part of their RAP monitoring process is still cumbersome and time-consuming, as one of the agencies reporting to Palmetto, they knew they had to make some investment in technology that would make reporting easier and provide them with advance warning that they were in danger of auto-cancellation.

To that end, they began using an ABILITY product that alerts the main office when they are close to being overdue and tells them what, if anything, is missing from the claim. Patton said their rejection rate was 10 percent to 15 percent before they began using the software, but has been reduced to less than 5 percent. 

What many home healthcare agencies may not realize, said ABILITY’s Meadows, is that as technology has progressed, affordable technical solutions are available to make the RAP process easier and help them avoid auto-cancellations.

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