Scenario / Background:
HH PPS Claims When No RAP is Submitted - “No-RAP” LUPAs.--All episodes for which payment based on HIPPS codes will be made, a RAP and a claim must be submitted. However, there may be circumstances in which an HHA is aware prior to billing Medicare that four or fewer visits will be supplied in the episode. In these cases, since the HHA is aware that the episode will be paid a low utilization payment adjustment (LUPA) based on national standardized per visit rates, only a claim may be submitted for the episode. These claims will be referred to as “No-RAP LUPA” claims.
HHAs may submit both a RAP and a claim in these instances if they choose, but only the claim is required. HHAs should be aware that submission of a RAP in these instances will result in a recoupment of funds for the episode since the payment for a RAP will exceed payment for four or fewer visits. HHAs should also be aware that the receipt of the RAP or a “no-RAP LUPA” claim causes the creation of an episode record in CWF and establishes an agency as the primary HHA which can bill for the episode. If submission of a “No-RAP LUPA” delays submission of the claim significantly, the agency is at risk of not being established as the primary HHA for that period.
FINANCIAL - Billing - Assessment Tracking
Search/select desired patient then search for 'ALL' assessments for patient
Click the light blue box to the left of the patient name / assessment line
Click the ‘pen/notepad’ icon to display the entry form
In the Override Status drop-down list, select No-RAP LUPA