Welcome to Monday Minute with Melinda! This week’s video offers quick tips on ensuring that you are coding appropriately for requesting an exception to a late RAP in 2021.

Today we are going to talk about the late RAP situation and what you should be doing to request an exception to a late request for anticipated payment. A couple of main reasons that you might encounter a late RAP, at least at this point, is due to a Medicare MAC claims processing issue. I am sure you have experienced multiple claims processing issues since January 1 where there were edits that were not working and caused your RAP to be late. There is also the situation that has become more prevalent when an agency admits a patient that has been with another home health agency in the most recent 30-day period. If an agency is admitting a patient that is overlapping a previous 30-day period, you will be required to use the 47-condition code as you always have been, in order for that RAP to process as paid. In addition, you would need to use the 47-condition code on the final claim.

What has been happening is agencies have not been finding the billing from the previous agency in the system and there not having any idea this patient has been with another agency. That being the case, they billed their RAP in the five-day timely filing window, and it has gone to T-status because of the overlap of a previous agency. You are going to want to add that 47-condition code to the RAP so that it will process and if it were late, you should ensure you have proof of Eligibility Verification information to show another agency was not in the home or was not at least in the system. Also, they had not billed for you to know that they were there, then you would be granted the exception. So, with the claims processing system with the Medicare MAC, you again would be able to request the exception.

When filing your final claim, not the RAP (the final claim), you will include the KX modifier on the HIPPS code line. In the KX modifier box, you will include the KX modifier. In addition to that, you will need to explain in the remarks section of the claim why you are requesting an exception, exactly what the circumstances were, etc. If you are in a situation where the detail remarks that you include does not give the Medicare MAC enough information to process your final claim cleanly and without penalty, they could request a non-medical ADR. This means you would need to send in additional documentation to support the exception that you have requested. Once that has been properly received and reviewed, you should be granted the exception. Make sure if you are overlapping a previous agency and there’s evidence in the system that they have already billed, that you do include that 47-condition code on your RAP when you initially bill it. You will not have an issue with timely if there is a Medicare claims processing issue, and also included in the exceptions or natural disasters and things of that circumstance. Regardless, if you are requesting an exception because of a late RAP, you will need to include the KX modifier in the modifier section when processing the final claim, and make sure that you include in the remarks section enough information for the Medicare MAC to properly process your exception.

Thank you so much for listening today. Hopefully, we have helped with your processing of late RAPs in the requesting of an exception with final claims. Feel free to give us a call or send us an email if you have any additional questions. Also, make sure to check with your state homecare associations for assistance or additional education that they might be providing. Thanks again and I hope you have a great week.

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