U538F

FISS Narrative
A Request for Anticipated Payment (RAP) or final claim overlaps an existing episode with the same provider number and the "FROM" date equals the episode's start date OR a visit date on a final claim falls within another episode established by another home health agency (HHA) or the billing HHA. 

Explanation and Suggestion
The only time HHAs should submit a second RAP during an episode that they have established is when the beneficiary is discharged due to meeting the goals of the plan of care and is readmitted to the agency during that same 60-day episode. Refer to the Medicare Claims Processing Manual 100-04, Chapter 10, Section 10.1.5, 10.1.14 and 30.9.

HHAs receive this error most often when they submit a second RAP for an episode where the final claim for the same episode was previously submitted and rejected (FISS status/location (S/LOC) R B9997). 

Submit only one RAP and final claim for each episode of care. If the final claim for the episode rejects, do not submit a second RAP. The final claim will need to be adjusted or resubmitted. Prior to admission or submitting RAPs/claims to Medicare, check the beneficiary's eligibility file to review established home health episodes which may impact your dates of service.

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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