• Petria

    June 11, 2020 at 7:11 pm

    Hi Kimberly.

    I will try my best to explain.

    According to the Federal Register, a RAP is not a claim. It is not called a claim when you are performing your billing and submitting it. Only the final claim is referred to as a claim during submission.

    However, if that same RAP & final claim were to be reviewed and then, say they were to accuse you of fraud, at that time the RAP will be considered as a claim the same way the final is considered as a claim

    The Medicare Claims Processing Manual says:

    10.1.12 – Request for Anticipated Payment (RAP)
    (Rev. 4489, Issued: 01-09-20, Effective: 01-01-20, Implementation: 07-01-19)
    The HHA submits a RAP to their A/B MAC (HHH) to request the initial split percentage
    payment for an HH PPS episode/period. The RAP may be submitted after receiving
    verbal orders and delivering at least one service to the beneficiary. Though they are
    submitted on standard institutional claim formats, the RAP is not considered a Medicare
    home health claim and is not subject to many of the stipulations applied to claims in
    regulations. (NOTE: RAPs may be considered claims for purposes of other Federal laws
    and regulations.) In particular, RAPs are not subject to the payment floor, are not subject
    to interest payment if delayed in processing, and do not have appeal rights. Appeal rights
    for the episode are attached to claims submitted at the end of the episode.

    I hope this helps to explain it.