In this document, you will find instructions for billing RAP for Medicare PPS and for other plans requiring Medicare-like billing. 

From the Main Menu go to Billing > PPS Billing > RAP Claims.

2021 billing will need to be generated separately from claims prior to 2021. 

2021 Billing

This process applies to Medicare, or any other PPS payer that is marked as using NOA 2022 (Codes > Payers > Electronic Claims Setup > NOA 2022 Start Date).

• The checkbox to use billing rules 2021 and later should be checked by default.
• Change the From and Thru dates, if needed.
• Click on Update Episodes.
• A report will generate if new 2021 episodes are found that meet the 2021/2022 RAP/NOA rules. These will be episodes added to the PPS tracking and have not been generated on a claim yet. 
• A RAP Error report will generate, if applicable. 
• After closing either report click the payer you need to create RAP claims for. 
• Any episode that shows up will be ready for RAP claims.  See detailed article here for full guidelines RAPs Billed with Service Date 01/01/2021 and Beyond (Billing, Medicare, RAPS) (barnestorm.biz)
• Click the Create Billing - 5010 button on the right. Wait while the software creates the RAP claims.

Claims prior to 2021

• Select a From and Thru (max thru date is 12/31/2020)date for RAPs to be included.  The Episodes From date will automatically be set to the oldest From Date that has not been billed, that still qualifies as billable under Medicare guidelines. 
• You have the option to select episodes that have an exported OASIS or where the OASIS is in the Locked status - we recommend using the Exported status.  
• You have an option to select F2F Required for SoC Episodes.  Check this to prevent RAP claims from being sent before the F2F has been verified. 
• Click the Update Episodes button near the top middle of the screen. Wait a moment; the software is matching OASIS and visits to unbilled episodes, so it may take a few minutes.
• A RAP Error report will generate, if applicable. 
• You may correct the errors and then return to billing. Click the Close button to close the errors.

• Select the payer you want to bill from; the list of payers available to bill from are located in the middle pane (ie. 01/001 Medicare A).  The number next to the payer name is the number of RAPs that are ready for billing. 
• The patient's with RAP episodes ready to bill for that payer will appear in the left pane.  
• To remove RAPs not ready to be billed:

a. In the upper left, click on the Chart Number of any RAP you do not want to include in billing.

b. The chart number will move to the bottom center pane, under Episodes Removed From the Selected List.

c. If you change your mind, you can click the chart number from the bottom center pane, and it will move back to the upper left pane, which is the list of episodes for billing.

• Make sure that the list in the upper left shows the RAP episodes you wish to bill.
• Click the Create Billing - 5010 button on the right. Wait while the software creates the RAP claims.
• You may receive a warning message that a doctor may have a missing or invalid NPI.  If so, take note of the patient and make the correction.  You will need to exit the RAP screen, correct the problem then restart the RAP process. 
• When the RAP transmission is complete, a new file has been created, and the name is shown at the top of the screen.
• Click the icon with the printer in the upper left corner to print the list of episodes.
• Click the X in the upper right corner to close the printer page.

**Note that the right side of the screen indicates that the create RAP claims is complete, and shows the transmission file name.

The following steps are optional if you need to print the RAP for payers that are not electronically transmitted

• Click Print UB04/1500 at the top of the screen. 
• Select the payer you just created the RAP on.
• Click the RAP button. The RAP claims will show up on the left side of the screen under the list of payers. 
• Click the serial number of the RAP claim you want to print.
• At this point if you should insert UB04 paper into the printer, if needed. 
• Click the Print All Claims in This Batch button. 
• Click the icon with the printer in the upper left corner to print the claims.
• Click the X in the upper right corner to close the printer page.
  

• Mail or fax the claims according to the payer.