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Home Health Patient-Driven Groupings Model (PDGM) Final Claim Timeliness Calculator

Under the Home Health PDGM Medicare makes a split percentage payment for most HH PPS episode periods. The first payment is 20 percent in response to a processed Request for Anticipated Payment (RAP), and the second payment is 80 percent in response to a processed final claim. If the final claim is not received 90 days after the start date of the period of care or 60 days after the paid date of the RAP (whichever is greater), the RAP payment will be cancelled automatically by the Fiscal Intermediary Standard System (FISS). For additional information, refer to section 40.1 of the Medicare Claims Processing Manual (CMS Pub. 100-04, Ch. 10)External PDF

Use this tool to prevent your RAP for periods of care that begin on or after January 1, 2020, from being auto-cancelled by the Fiscal Intermediary Standard System (FISS).

Start Date of PDGM Period of Care:

Paid Date of RAP:

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.


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