Q: We have a patient where the admitting nurse completed the SOC OASIS, and responded "yes" to M0825, anticipating the patient would exceed the 10-therapy visit threshold. The patient subsequently refused all therapy visits, but the assessment has been completed, scanned, locked, and submitted to the state. What do we do?
A: You do not have to do anything. Your original Request for Anticipated Payment (RAP) will be paid at the high-therapy HHRG, but this overpayment will be recouped with your agency's submission of the final claim, as the intermediary will automatically recalculate the HHRG when less than 10 therapy visits are reported on the final claim. The overpayment will be deducted from your final episode payment. This will not be a major issue, unless your agency "overestimates" therapy utilization much more frequently than the average agency. In order to address any potential complications related to the overestimation, it is recommended that you document the patient's refusal for therapy as an explanation for the "yes" answer to M0825, with no following therapy. You may also correct M0825, cancel and resubmit the RAP, however- at this time CMS has not required this.
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