Episodes not showing up to create RAPs

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

1. First, verify that the RAP 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 has already been created.

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.  Select Episodes for Billing screen:  

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

Thru Date:  The Thru date on the billing screen is set (by default) to 10 days ago. If the episode's From Date is during the most recent 10 days, this is why it is not showing up. You can change the Episode Thru Date to whatever you want, but the problem is the first visit of a recert episode may not be there yet - that's why the system defaults 10 days. 

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.  

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

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

You can view the following article on how to read Episode Status' on 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:  1. Check all the dates on the referral screen for that patient; and verify that the correct payer is listed under Payers tab of the Referral; 2. Check the 485 dates; and 3.  Check the OASIS dates.

Related Questions and Answers:

A. When is the best time to create RAPs?

Immediately after you have exported 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.

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

There are also various report options under Reports>Billing