RAP

•Requests initial split percentage payment for HH PPS episode 

– Initial episode = 60% split (40% for final claim) 

– Subsequent episode = 50% split (50% for final claim) 

• Submitted after receiving physician’s verbal orders and after delivering at least one service to the beneficiary 

• Establishes agency as primary HHA 

• Opens new home health episode on CWF

Home Health Prospective Payment System: RAP

• RAP can be submitted when all of the following conditions are met: 

– OASIS completion 

– Physician’s verbal orders 

– Plan of care sent to physician 

– First service delivered 

• Submitted on TOB 322

OASIS Matching Key

• Treatment Authorization Code Field

 – First nine positions: dates used 

• Two-digit dates and alpha codes for Julian dates 

• One-digit code for reason for assessment 

– Last nine positions: episode sequence, clinical & functional scores, and case-mix equations

Final Episode Claim

• Submitted at end of 60-day period, when a beneficiary is transferred or when beneficiary is discharged

• Must be submitted after all services for the episode have been provided and physician has signed plan of care and all verbal orders

• Face-to-face encounter must have been completed prior to submitting the claim

• RAP payment recouped when final episode claim is submitted and 100% payment is made once claim processes