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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:


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