Bill RAP for Medicare PPS

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).

Claims prior to 2021

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.

**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

If you are sending claims electronically 

If you use a vendor like Ability or eSolutions to transmit your claims you will need to follow their directions on how to upload the claims.  To find out where on your machine the claims are being saved, go to Billing > HIPAA Transactions > Edit HIPAA Payers.  Select the payer you are interested in and look at the "Transmit Folder" field for the location of where those claims are being saved. 

Face to Face and RAPs
Most new admissions will have the F2F before admission, and of those that don't, they do soon enough so the RAP is not postponed that long. The reason the F2F checkbox is on the RAP screen is to try to prevent RAPs being sent and paid where the agency is unable to obtain the F2F, and then has to cancel everything.  So even though F2F is only required for the EOE, if you can't get F2F certification, then you never send the RAP. We recommend using Barnestorm F2F order category to send & record F2F orders so that they are trackable and reportable.