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June 23, 2021

Update: The RAP Penalty and Your Remittance Advice

We first told you in the article, What You Need to Know About the Home Health RAP Penalty, that your Medicare Standard Paper Remittance (SPR) Advice would display the request for anticipated payment (RAP) payment reduction.  This article was posted to our website and sent in an electronic email on April 7, 2021.

An update was implemented to remove this information.  To determine if a RAP payment reduction has been applied to your claim, due to late RAP submission, review the claim by accessing the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE).

  • The RAP penalty displays on FISS DDE Claim Page 01 with the value code QF and the amount of the payment reduction.  It also displays the Claim Adjustment Group Code CO (contractual obligation), and Claim Adjustment Reason Code (CARC) 95.

    FISS DDE Example– Page 01

    FISS DDE Example

Resources:

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