Home Health's Transition to Monthly Billing

The decrease in the RAP payment in January 2020 was just the beginning of our transition away from split billing to once a month billing in home health. The fact that the change was concurrent with PDGM helped to intensify its effects.No doubt many agencies were just getting their footing back when COVID-19 hit and cash flow was once again decreased.
Below is a table to explain the progression of the RAP and split billing to the Notice of admission (NOA) and once monthly billing.
RAP20202021NOA 2022
TimelineEach 30-day periodEach 30-day periodOnly at the start of care
5-Day PenaltyNoYes*Yes*
Requirements to file1.Physician's orders have been received and documented.
2. The first billable visit has been completed.
3. OASIS is complete, locked or export ready.
4. Plan of Care has been established and sent to physician for signature.
1. The appropriate physician’s written or verbal order that sets out the services required for the initial visit has been received and documented.
2. The initial visit within the 60-day certification period must have been made and the individual admitted to home health care.
1. A written or verbal order from the physician (containing the services required for the initial visit) signed and dated by the physician, and if verbal, signed and dated by the registered nurse or qualified therapist responsible for furnishing or supervising the ordered service in the plan of care signed by the physician;
2. The HHA to conduct the initial start of care visit.

OperaCare's combination of consulting and data driven quality assurance is bringing peace of mind to our users. The Operacare system empowers your agency to thrive in PDGM, RCD and any value-based model of care.

Schedule a call today to learn how you can stop worrying about unpredictable margins and frustrated clinicians, and instead increase clinician productivity while achieving stable, predictable margins!

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