Simione™ Healthcare Consultants

A rocky start for new 5-day, no-pay RAPs

As new billing headaches greet the new year, Simione’s experts prepare for more agencies to turn to outsourced coding and billing 

Most home health agencies rang in the new year with an assortment of billing headaches, including a rocky start with changes in Requests for Anticipated Payment (RAPs). Under new Medicare regulations, RAPs must be submitted and accepted by the Medicare administrative contractor within a 5-day timeframe to avoid stiff penalties. Agencies are scrambling to make certain clinicians close out work in a timely fashion and get billers the necessary documentation to dodge the penalties.

The process has been frustrating even at agencies where the staff prepared in advance with procedures designed to expedite the process.

“One of the first obstacles out of the gate was when Medicare systems began returning RAPs to agencies because they didn’t have a value code 61. But these weren’t really RAP errors, because value code 61 is optional for home health RAPs in 2021,” said J’non Griffin, President of Home Health Solutions, a Simione Coding Company.

More challenges ahead

Frustrating glitches such as RAPs being returned to providers are likely to be the first of many new billing problems for home health agencies this year, according to Griffin.

And it could get much worse than system glitches. Cash flow shortages are predicted at many agencies by the end of the first quarter, now that RAPs no longer provide any upfront payments. Coupled with penalties for late submission, this could create serious financial difficulties industry wide.

Uncertainty about the financial impact of new RAP requirements and the continuing financial impact of Medicare's PDGM is spurring an increasing number of agencies to consider outsourcing their billing and coding services, Griffin said.

“Agencies are feeling highly frustrated and exhausted by the continuing challenges impacting their profitability,” she said. “They’re ready to focus on what they do best – patient care – and they’re looking for packaged billing and coding services so they can get out from under the burden of these distractions.”

Simione prepared to help 

To prepare for the anticipated influx of new outsourcing queries and clients, Simione Healthcare Consultants has expanded its pool of experienced consultants to provide outsourced billing services in addition to the coding services provided by Griffin's team at Home Health Solutions.

Simione's trained and knowledgeable billers are backed by five decades of industry-leading experience in clinical and financial consulting services, and operate under the direction of well-known industry leaders, including Robert Simione, CPA, Director of Financial Consulting for Simione, and Kimberly Chapman, Senior Manager in Financial Consulting and Revenue Cycle Management.

Rob Simione brings to the table a renowned focus on analyzing and managing finance and data resources, including benchmarking, budget, revenue cycle and financial management leadership. Chapman has more than 15 years of experience across billing, claims analytics, EMR/technology analysis, and quality/process improvement disciplines.

Their expertise complements Griffin's nationally recognized leadership in coding and OASIS review, as well as clinical and financial advisory experience, to provide full revenue cycle support to agencies.

Taylor Small is ready for questions

There's a new face in the Simione mix, too, who will be helping clients learn more about the benefits of outsourcing.

Taylor Small has been appointed as a Business Development Executive, focusing on sales and customer support for outsourced billing, coding, and OASIS review.

Small, has a decade of experience in home care, hospice, and private duty sales and relationship management, most recently as an account manager for MatrixCare. She previously served as a lead generation specialist with McKesson, as a sales representative for Optima Healthcare’s hospice EMR solution, and as an account executive for Sprint Business Solutions.

“I’m excited to become part of the Simione/Home Health Solutions family,” Small said. “Throughout my work in the home health and hospice industry, I have been aware of the quality of work provided by this team. It feels great to have complete confidence in the services that I will be selling. Our customers trust us with their business so they can focus on providing quality care.”

Billing and collection services

Timely and accurate coding is an essential piece of the revenue cycle under PDGM, accounting for up to three-fifths of an agency’s total reimbursement. Efficient and compliant billing practices avoid costly delays and denials. Together, these services provided by a trusted provider can shore up profitability and have a marked impact on an agency’s bottom line.

Bundled coding and billing services are available now at a cost savings from Simione. Existing Home Health Solutions coding and OASIS review clients will qualify for savings when adding outsourced billing services.

Simione’s outsourced billing services include the resources to:

  • Bill and collect for Medicare, Medicaid and commercial payers
  • Optimize electronic billing
  • Monitor daily RTP status, ADRs and denials
  • Complete cash posting
  • Communicate with operations to resolve unbilled accounts
  • File NOE/NOTR to support daily hospice operations

Learn more about our services and get a free quote.

Have a question for Taylor Small about outsourcing benefits? Reach her directly at [email protected] 


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