To All Home Health Clients:
2021 PDGM RAPs
myUnity
Essentials Financial program changes are in the final stages of
completion to accommodate the CMS regulatory changes
effective for PDGM billing periods beginning January 1, 2021.
These changes include:
- The
SOC RAP can be submitted when the physician written or verbal order
has been received and documented, the initial visit has been made and
the patient is admitted to HH care.
- RAPs
must be submitted within 5 calendar days after the start of each 30-day
period of care or the agency incurs a 1/30th final payment reduction
for each day submitted late.
- RAPs
pay 0% of final payment for all 30-day periods of care beginning on or
after 1/1/2021. This applies to all Home Health agencies.
- Medicare
allows RAPs for the second 30-day billing period within a certification
period to be submitted beginning on the certification start date.
myUnity Essentials Financial will allow billing it as early as day 2 of
the cert period to ensure unique Bill Dates are used.
- For
LUPA periods in which the RAP isn't submitted timely, no LUPA per-visit
payments would be made for visits that occurred on days that fall
within the period of care prior to the submission of the RAP.
In
version 1.2.8.69, the Pre-Billing Audit and Billing Audit will evaluate
a SOC RAP as Ready to Bill when the Verbal Order or Plan of Care and a
skilled visit (in Pending or Completed/Verified status) are present in
Billing. If the OASIS is not present, a default PDGM HIPPS of 1AA11
will be submitted on the claim.
In Clinical,
a 'RAP Notice Verbal Order' form with a primary diagnosis entered can be used if the agency is unable to
complete and export the SOC assessment within the first five days of
the certification period. This RAP Notice form will generate a Verbal
Order (VO) record type in Billing when exported from Clinical.
Further information on PDGM changes will be available prior to the end of year.
To All Hospice Clients:
VBID Model CY 2021
Beginning January 1, 2021 a Medicare Advantage Organization (MAO)
participating in the Value-Based Insurance Design (VBID) Model may be
selected by Medicare Part A patients electing the hospice benefit. The
VBID program requires agencies to submit all claims and notices of
election (NOE) to both the participating MAO and their Medicare
Administrative Contractor (MAC). Information can be found on CMS
site https://innovation.cms.gov/innovation-models/vbid.
Please contact Support if you expect patients at your hospice agency to select a MAO for their hospice benefit in 2021.
To All Clients:
Maintenance Schedule
Effective immediately, we will be instituting monthly system
maintenance from 8:00 – 11:00 PM ET on the THIRD Sunday of each month to ensure
that your remote working environment is up to date on all security and
performance benchmarks. During this time you may experience connectivity
and/or performance issues while the updates are being performed. We apologize
for any inconvenience this may cause, but hope you understand your data’s
security and integrity is our priority.
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