RAP Claims Errors

?Episode date is not the patient’s start of care date 

The report will show you which episode it is referring to.  Check the following places to verify that dates are correct:

1) Check to make sure all dates match

  • Referral > Referral Information > Admit Date
  • 485 From and Thru dates
  • Visits/Assessment first chargeable visit should be the admit date

If any of that information is incorrect then you will need to fix it.  Go back to the RAP Claims screen and run the error report again.

You can also try deleting the episode from Billing > PPS Billing > Edit PPS Episodes.  Then going back to the 485 screen and select the correct episode then click the Create PPS Episode button. 

2)  Go to Billing > PPS Billing > Edit PPS Episodes and pull up the patient.  Check to see if the patient has an incorrect episode showing at the top of the screen.  If the 485 dates were incorrect at any point when it was printed, an episode would generate.  Usually there would be two episodes; one with the correct date and one with the incorrect date.  Select the incorrect episode and then click on the Delete This Episode button.

?The patient does not have xx/xxx as a pay source (xx/xxx is the payer numbers on your screen) 

There’s a couple places to check and you’ll need to know which piece of information is correct:

Pull the patient up from Select Patient and go to the Referrals > Payer screen.  Check to see if the patient has the payer listed.

Go to Billing Inquiry > Visits and check to see if any of the visits have that payer listed on them.

Now you’ll need to figure out if the patient is supposed to have that payer listed on the Referral. The error is showing up because Billing > PPS Billing > Edit PPS Episodes has this payer as the primary payer.  If the first chargeable visit had this payer on the charge at the time the 485 was printed, then it would pull that payer number.  This does happen often where the payer is changed shortly after. 

If the payer is incorrect on the Edit PPS Episode screen and is correct on visits:

Go to Billing > PPS Billing > Edit PPS Episode and select the incorrect episode with the wrong payer.  Click the Delete This Episode button.

Go to the 485 screen and select the episode and click on Create PPS button.  At that point it should correct the episode. 

?No 485 Found With This Date 

At one point there was a 485 entered with the date shown on the report.  When the 485 was printed it created an episode with that from and thru date.   At some point the 485 was deleted.  You will need to find out if it was deleted for a reason or by mistake.

  1. If the 485 was deleted because it was in fact incorrect then go to Billing > PPS Billing > Edit PPS Episode and select the incorrect episode and then click on Delete This Episode. 
  2. If the 485 was deleted by mistake then you will need to have it entered again. 

? 485 From [Date] Not Mailed

The 485 for the episode has not been mailed yet, which is a requirement before a RAP can been submitted. 

?No ICD Codes Found For This Date

There is a ICD history entered for the patient but it is not on or before the From date of the episode.Go to the ICD History screen and correct the main date or create a new one that is on or before the From date of the episode.

? Physician is NOT enrolled in PECOS, or is missing the first or last name For Doctor

If the physician is not enrolled in PECOS, the RAP will not generate for billing.  This is an example of the error you will receive:  "Doe, Jane (222234) Doctor Has a Missing or Invalid NPI."  Medicare Episodes with a doctor not enrolled in PECOS will be denied by Medicare.  PECOS enrollment is a CMS requirement.  If you have any questions regarding this requirement, please contact CMS or your Medicare representative.

? No 485 Found With a From Date of xx/xx/xx - PPS Episode Deleted 

The following rules are looked at before deleting the episode:

  • Checks to see if the episode is on a 60-day interval from the admit date;
  • Checks that if there are chargeable visits to that PPS payer;
  • Checks for an OASIS with a HIPPs code and Validation Date

? Episode is not showing up on RAP Claims list

Select Here for a separate article with several tips on what to check if a RAP is not appearing on the list. 

EOE Claims Errors

Face-to-Face documentation missing

The Face to Face may not be received yet.  Check the chart to make sure you have the order.  Once you verify it is in the office signed then go to the patient's 485 screen and select the episode and check the box for Face to Face verified.

POC Chrg Visit is not Locked+Chg

Let's you know if any assessments are not in the Locked+Chg status.  Go through your agency's process of locking the assessments when ready.Visit Assessments from POC are Locked+Chg through the Employee Activity > Visit Entry screen or the Employee Activity >Import Visits screen.  Each agency defines how old the visit must be before it will become locked and charge.  So if the assessment is newer and it does not appear on the list to become locked and charge (imported) then that may be the reason.  Check with your agency’s policy to see how old the assessment must be. 

485 not returned –Verbal Orders Outstanding

Either the 485 or verbal orders are not received back from the doctor.  You may want to check the chart to see if it has already been received, but maybe not tracked back in Barnestorm.  If Orders are not back yet then it will list all orders that are outstanding.

1st Chrg Visit Date Changed since RAP

This means that the RAP was created with a visit charge but the first chargeable visit has changed since.Ways to verify this is to go to Billing > PPS Billing > Edit PPS Episode.  Pull up the patient and select the episode with the error.  Look at the field 1st Visit Date.  This is the first chargeable visit that was placed on the RAP.Now go to Visits/Assessments and look for the first chargeable visit.  For Start of Care it should be the admit date; for Recert it will be the first chargeable visit on or after the From Date - this is usually where the problem is.Late entry of visit charges will cause this error.

Other

  Episode does not show up at all

Verify that the OASIS sequence date is on or after the patient's admit date.

Verify that the episode hasn't already been created: Billing > PPS Billing > Edit PPS Episodes.