Knowledge Base Article #808:

Medicare PPS - RAP Pended Claim Report

FINANCIAL - Billing - Invoice Processing: [Medicare PPS Episode cycle] [RAP]

Click the [View / Print Details] button in the PENDED CLAIMS section.  A second browser will open and display a PDF report.  The report is intended as a follow-up document to assist you in resolving conditions that caused a RAP to be pended (placed on-hold).  There are two main section in the report; a RAP section and an UNPROCESSED CLAIMS section.

The RAP section of the report contains Patient Name, Patient ID#, Claim 'From' Date, Claim 'To' Date, Type of Bill, HIPPS Code, HHRG Reimbursement Amount, and four columns indicating specific follow-up. 

Asmt Needed: If YES, then an episode-establishing assessment (type 1 or 4) needs to be entered into patient clinical record.

Asmt Lock Date: If YES, then an episode-establishing assessment (type 1 or 4) is present in the patient clinical record but it is not VALIDATED (locked/ready for transmission).

Tx Plan Needed: If YES, then a Plan of Treatment (485) needs to be entered into patient clinical record.

1st Visit Needed: If YES, then a billable visit on SOC date needs to be entered into patient transaction record (where discipline is not HHA).

The section footer includes Patient Count, Claim Count and HHRG Reimbursement Amount Total.

The UNPROCESSED CLAIMS section of the report contains Patient Name, Patient ID#, Claim 'From' Date, Claim 'To' Date, Type of Bill, HIPPS Code, HHRG Reimbursement Amount, and four columns indicating specific follow-up. 

Asmt Needed: If YES, then an episode-establishing assessment (type 1 or 4) needs to be entered into patient clinical record.

Tran Lock Date Needed: If YES, then an episode-establishing assessment (type 1 or 4) is present in the patient clinical record but it is not VALIDATED (locked/ready for transmission).

LUPA Visit Count Exceeded: If YES, then the asmt billing status had been previously indicated as a 'No-RAP LUPA' but the system has detected a visit count over the LUPA Threshold.

Therapy Threshold Exceeded: If YES, then the asmt M0825 response is NO but the system has detected a therapy visit count that warrants a M025 response of YES..

The section footer includes Patient Count, Claim Count and HHRG Reimbursement Amount Total.

Please click Preview Attachment link at the right to view a sample RAP Pended Claim Report.

Keywords: careportal, Medicare, billing, PPS, report, pended claim, RAP
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