Serving the home health, home care and hospice industry since 1999.

by John Reisinger, CPA

On September 24, CMS updated its policy regarding the so-called "No-Pay RAP," which is set to replace the existing Request for Anticipated Payment system on January 1, 2021. The announcement came via an MLN titled: Penalty for Delayed Request for Anticipated Payment (RAP) Submission -- Implementation

Here are some of the changes:

  • The 20% RAP (payment) is eliminated
  • There is now a five-day window from the SOC to submit the No-Pay RAP to be considered timely (i.e., SOC date + 4 days)
    • If the No-Pay RAP is sent on/after the sixth day (SOC date + 5 (or more) days), there is now a financial penalty that will be applied against the HIPPS payment. There are some prescribed exceptions. (Read the notice)
    • The financial penalty will be a reduction to the HIPPS payment based on the following calculation:
      • The day number the No-Pay RAP is submitted ÷ 30  (the day number is the count of days after the SOC (and the SOC is Day 1) that the No-Pay RAP is submitted)
      • So any No-Pay RAPs submitted between the SOC date (for that 30-day pay period) or within the next four days, will ALWAYS be penalty-free
      • The first day a penalty could be imposed would be for a submission on Day 6 (SOC date + 5 days)
        • The calculation would be:  6 ÷ 30  (20%).
        • Therefore, the smallest penalty would be a reduction of your PPS (HIPPS) payment rate of 20%
      • And if the No-Pay RAP is submitted on or after day 29 after the SOC date (meaning on or after day 30), the penalty reduction would be 100%

The bottom line, obviously, is DO NOT submit your No-PAY RAPs late!


Just How Serious?

This is not as big a deal as many would lead you to believe. As the implementation of the No-Pay RAP has no cash exchange implications, CMS has greatly reduced its submission document requirements. Notice this section of the MLN document:

"Starting in CY 2021, the split-percentage payment would be lowered to 0 percent for all HHAs, both newly enrolled and existing. However, all HHAs would still be required to submit a RAP at the beginning of each 30-day period of care (84 FR 60548). Since no payment will be associated with the submission of the RAP in CY 2021, HHAs are to submit the RAP when:

  1. The appropriate physician’s written or verbal order that sets out the services required for the initial visit has been received and documented as required at 42 Code of Federal Regulations (CFR) Sections 484.60(b) and 409.43(d); and
  2. The initial skilled/chargeable visit within the 60-day certification period has been made and the individual is admitted to HH care (84 FR 60548)
The information needed for submission of the RAP in CY 2021 will mirror the one-time Notice of Admission (NOA) process, also finalized in the CY 2020 HH PPS final rule with comment period, starting in CY 2022 (84 FR 60549).

Therefore, there should be a significant simplification for this No-Pay RAP submission process as compared to the current RAP submission process. There is no need to make this bigger and more dramatic than what it is. The big change is that the 20 percent anticipated payment is eliminated, but most agencies should be able to weather this change with minimal or even zero impact to their operations. The best-positioned agencies will be those that have already worked to become as efficient as possible, eschewing the "this is how we have always done it" approach in favor of "Let's look and see what we should be doing."

©2020 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Home Care Technology: The Rowan Report. One copy may be printed for personal use; further reproduction by permission only.