•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
