Why HHAs Must Shorten Days to RAP / POC submission to Survive PDGM

Does your HHA keep track of the time it takes from OASIS visit to billing the RAP and submitting the plan of care?This may be the single most important indicator of success in PDGM.This metric is often an indicator of the productivity of an HHA as well as the effectiveness of its management and operations. Often HHAs are using the 5-day requirement for OASIS completion as their "gold standard" allowing clinicians to take the entire 5-days to turn the assessment into the HHA.The 5-day requirement should be considered the "worst case scenario" instead of best practice. See the wording from the COPs below...

§484.55(b)(1) The comprehensive assessment must be completed in a timely manner,
consistent with the patient’s immediate needs, but no later than 5 calendar days after
the start of care.

To be effective in this process requires every member of your team to be working efficiently.I encourage your HHA to take a look and determine if there is a time lag in any area in your agency-

  • Marketers/ community liaisons
  • Intake and scheduling
  • ICD-10 coding
  • OASIS assessment and documentation
  • Quality assurance
  • Billing staff

Below are several reasons this should be a major concern in PDGM.

  • 12-14 days is almost half of the first 30-day period in PDGM.
 Clinicians without a POCtend to teach on generic topics increasing their patient’s risk forhospital re-admissions and decreasing the potential for good patient outcomes
  • 12-14 days will have your HHA chronically behind in billing.
 Because RAPs only pay 20% now, billing the final must happen timely for optimum cash flow
  • 12-14 days in an RCD state means your first 30-day period is half over before you can send inforapproval in pre-claim review

Is your HHA convinced it needs to reduce time to RAP/ POC but overwhelmed when trying to figure out how? OperaCare has a proven system of consulting and analytics built to centralize operations and increase productivity for your PDGM success.  


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