Home Health Articles and Information


Oct 20, 2020 7:30:00 AM / by Kristi Bajer, BSN, RN, COS-C

Avoiding the 5-Day RAP Penalty in 2021

There are two special circumstances to consider going into 2021 that could affect the timeliness of your agencies RAP submissions.  Agencies must be proactive to prevent or reduce the chance of accruing RAP penalties in these situations.  The two circumstances are...
  • RAPS filed late due to an exceptional circumstance
  • RAPS filed timely, but later canceled and resubmitted to correct an error

CMS has outlined four specific circumstances in which they will make an exception to the timely filing rule. Here is the information from the Medicare Claims Processing Manual...

"If an HHA fails to file a timely-filed RAP, it may request an exception which, if approved, waives the
consequences of late filing. The four circumstances that may qualify the HHA for an exception to the
consequences of filing the RAP more than 5 calendar days after the HH period of care From date are as
1. fires, floods, earthquakes, or other unusual events that inflict extensive damage to the HHA’s ability
to operate;
2. an event that produces a data filing problem due to a CMS or A/B MAC (HHH) systems issue that is
beyond the control of the HHA;
3. a newly Medicare-certified HHA that is notified of that certification after the Medicare certification
date, or which is awaiting its user ID from its A/B MAC (HHH); or,
4. other circumstances determined by the A/B MAC (HHH) or CMS to be beyond the control of the

It is the home health agency's responsibility to provide the information in the remarks section of its claim for the requested exception to be approved.  If this information is missing or incomplete the Medicare contractor will request more information, which of course will hold up your claim and may reduce your payment.

In the second scenario, an agency submits a RAP in the timely filing 5-day window but later realizes there is an error that requires them to cancel the RAP and resubmit with a correction.  The corrected RAP submitted beyond the 5-day window will automatically trigger a RAP penalty unless the agency includes remarks about the situation.  The remarks should indicate that the original RAP was filed in the 5-day window, "Timely RAP on (date) canceled due to error and resubmitted".

If you would like more information about the RAP in 2021 please see the article links from CMS and other OperaCare blog posts below

Read the MLN Matters 11855 here

Read the full length Pub 100-04 Medicare Claims Processing Change request 11855 here

For a quick reminder of the RAP requirements in 2021 click here

For a breakdown of how the 5-day RAP / NOA penalty works click here


Tags: PDGM, Co-morbidity, Home Health, 5-Day RAP Penalty

Kristi Bajer, BSN, RN, COS-C

Written by Kristi Bajer, BSN, RN, COS-C

Kristi Bajer BSN, RN, COS-C, brings over 10 years of real world experience as a clinician, director, and administrator in home health. She is a firm believer in diagnosis driven evidence-based care in home health. Currently, she assists agencies with external chart audits and Medicare appeals, as well as providing training and coaching on OperaCare implementation and building QAPI programs using data to drive success and protect agencies from government audits.