Episodes Not Showing up to Create RAPs/NOAs

Try these troubleshooting steps if your episodes are not showing up when you try to create a RAP/NOA:

1. First, verify that the RAP (NOA) has not already been billed.  You can verify this under Billing PPS Billing Edit PPS Episode and check the RAP Date field.  If a date is listed then a RAP (NOA) has already been created.  If you need to cancel the RAP/NOA due to a submission error, follow the steps here to cancel it.  Make your necessary changes, then recreate the RAP/NOA.

2. Go to Codes > Program Related Codes > Payer Codes – Make sure PPS Field = Yes for the payer you are billing.

3. Verify that the episode has been created.  From Barnestorm Main Menu, select the patient (by first name, last name, or enter the chart number).  Click on 485 tab, select the 485 for that episode, and click Create PPS tab. ( If the clinician did not preview the 485, the episode did not get created.)

4.  Billing > PPS Billing > RAP Claims > Select Episodes for Billing screen:  

From Date:  Verify that the episode From date (date on the billing screen) includes the RAP (NOA) date that you are trying to bill for.

Thru Date:  The Thru date on the billing screen is set (by default) to 2 days ago. If the episode's From Date is during the most recent 2 days, this is why the episode is not showing up. You can change the Episodes From Date and Thru Date as needed.

OASIS is:  Go to the OASIS and verify if it has been locked or exported.  Verify that the appropriate bullet is selected on the billing screen.  (For Episodes prior to 2021)

5.Make sure the OASIS has a HIPPS code.  If not, check the value of M0150 -It must be Medicare or Medicaid to create a RAP.  If a particular payer requires a RAP, they may be a Medicare Advantage Plan which means that M0150 must have a value of 2.  Also, verify that M0110 is not marked as N/A.  Follow these links:  Missing OASIS HIPPS Code or HIPPS Code is Missing on OASIS  (For Episodes prior to 2021)

6.  Pull up the PPS Tracking Report to get status of the episode.  Billing>Reports>14.03 PPS Tracking Report

Click here for details of the PPS Tracking Report.

7.  Verify that the episode has a first chargeable visit, and it is billed to the PPS Payer.

8.  If you recently changed the payer, for this patient, verify the following (along with steps above):

     a.  All visits have been moved to the correct payer

     b.  Referral Payers tab - Verify the correct payer is listed Primary

     c.  Billing PPS Billing Edit PPS Episodes - Select the episode and verify the correct payer is listed.  If not, hit the Switch Payer tab to get the correct payer.

9. If the above does not work, verify the following:

     a.  Check all the dates on the referral screen for that patient

     b.  Verify that the correct payer is listed under Referral > Payers

     c.  Check the 485 and OASIS dates (For Episodes prior to 2021)

Related Questions and Answers:

A. When is the best time to create RAPs/NOAs?

Immediately after you have exported the OASIS. This not only enables steady revenue, but this also ensures that your agency is noted as the primary HHA, for the beneficiary, in the CWF.  (For Episodes prior to 2021)

2021 and forward: NOAs must be submitted and accepted (by Medicare) within 5 days of the DOS to avoid payment penalties.  Click here for Q & A related to NOAs.

B. How can I track billing of RAPS and EOEs?                                                                             

There are several report options, go to:

Billing tab> PPS Billing>Review PPS Batches

Billing>Reports>14.03 PPS Tracking

Billing >Reports>14.33 Claims Sent, But Not Paid

Billing>Reports>RAP/EOE Sent for Selected Dates