Home Health Articles and Information


Dec 2, 2019 8:31:00 AM / by Kristi Bajer, BSN, RN, COS-C

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 POC  tend to teach on generic topics increasing their patient’s risk for                              hospital 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 in                for  approval 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.  


Schedule a 10 min Call to Learn More


Tags: PDGM, PCR, Home Health, Quality assurance, Home Health Care, RAP

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.