Incorrect Processing of Home Health Requests for Anticipated Payment (RAP)/Final Claims
Provider Types Affected
Home health providers who experienced incorrect processing of their RAPs and/or Final Claims between May 5, 2005 and February 13, 2008.
What You Need to Know
A review of the RAPs/Final Claims processed by Palmetto GBA for home health care services during the above-referenced dates has been completed. Upon completion of the review, it was determined that more than 4,000 home health providers were impacted by the incorrect processing of these RAPs and/or Final Claims.
Palmetto GBA developed three different letters (Refund, Overpayment and No Money Due letters) to be mailed to the impacted providers to notify them of their status in this process. We coordinated with a sample of the impacted providers to review the letters and reports and provide feedback to Palmetto GBA as to the effectiveness of our proposed process. Palmetto GBA received positive feedback from the sampled providers.
All of the impacted providers will be notified over the next several weeks by way of letter. Each provider which receives a letter will also receive a report of the affected RAPs/Final Claims. All letters will include the range of dates that the RAPs and/or Final Claims were processed. In addition, the Refund Letters will include the amount of the refund and an explanation as to why a refund is being made. The Overpayment Letters will include the total amount due to Medicare and the reason for the overpayment. The No Money Due letters will explain that as a result of the review of the RAP/Final Claim activity that no money is due the provider or Medicare at this time.
Providers should also know that if they are due a refund and have an existing Overpayment or Extended Repayment Plan (ERP), part or all of the refund may be applied to the balance due.
Background
From May 5, 2005, through February 13, 2008, more than 4,000 home health providers were impacted when the Fiscal Intermediary Shared System (FISS) incorrectly processed RAPs and/or Final Claims. As a result, a review was conducted on RAPs/Final Claims that were processed during the above-referenced dates to determine whether or not providers were due a refund. Of the total number of impacted providers, 90% are due a refund, 6% were assessed an overpayment and 4% will neither receive a refund nor be assessed an overpayment.