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February 15, 2021

Submitting RAPs for Recertifications

With the implementation of the Calendar Year (CY) 2021 Home Health Request for Anticipated Payment (RAP) payment policies, there is a new exception allowing providers to submit a request for anticipated payment (RAP) for the first and second 30-day periods of care at the same time. This would only be beneficial when the plan of care dictates multiple 30-day periods of care will be required to treat the beneficiary.

CGS has received questions from providers asking how to submit RAPs for recertifications. For recertifications, the first day of the period of care can also be reported as the date on the 0023 revenue code line. This allows providers to submit the RAP within 5 calendar days of the "From" date for subsequent 30-day periods. For example:

Patients start of care date
  • 01.21.2021
Initial 60-day Certification
  • RAP 0023 date for the 1st 30-day period of care in a 60-day certification period
  • Final claim billing period of the 1st 30-days
  • RAP 0023 date for the 2nd 30-day period of care in a 60-day certification period
  • Final claim billing period of the 2nd 30-days
  • 01.21.2021
  • 01.21.2021 / 02.19.2021
  • 02.20.2021
  • 02.20.2021 / 03.21.2021
Recertification (60-days)
  • RAP 0023 date for the 1st 30-day period of care in a 60-day recertification period
  • Final claim billing period of the 1st 30-days
  • RAP 0023 date for the 2nd 30-day period of care in 60-day recertification period.
  • Final claim billing period of the 2nd 30-days
  • 03.22.2021
  • 03.22.2021 / 04.20.2021
  • 04.21.2021
  • 04.21.2021 / 05.20.2021

Refer to the article MM11855 – Penalty for Delayed Requests for Anticipated Payment (RAP) Submission – ImplementationExternal PDF for additional information.

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