Home Health Articles and Information


Jul 7, 2020 6:00:00 AM / by Kristi Bajer, BSN, RN, COS-C

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.
RAP 2020 2021 NOA 2022
Pay 20% 0 0
Timeline Each 30-day period Each 30-day period Only at the start of care
5-Day Penalty No Yes* Yes*
Requirements to file 1.  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.


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Tags: Home Health, COVID-19, Home Health Care

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.