F.O.R.C.E. Healthcare Resources, LLC (Founded on Regulatory Compliance and Ethics)

1. F.O.R.C.E. Healthcare Resources, LLC(Founded on Regulatory Compliance and Ethics) Making Claims Correction December 12, 2012

2. About F.O.R.C.E.? • Home Health Consulting Firm – Founded 2005 Services Provided: • Home Health Billing Webinars • Home Health Outsource Billing • Home Health Outsource Medical Coding • Home Health Billing Clean-up Projects • Home Health Operation / Process Consulting • Home Health Financial Consulting • Home Health CLIA Billing & Recovery Project

3. Contact Information F.O.R.C.E Healthcare Resource, LLC. • Website: www.forcehealthcare.com • Terri Ready, COO • Direct: 423-643-2256 ext. 104 • Mobile: 423-593-1627 • tready@forcehealthcare.com • Lynn Alley, Billing Supervisor • Direct: 423-643-2256 • lalley@forcehealthcare.com • Jonathan Sellers, Sales & Marketing - Direct: 423-834-5334 - jsellers@forcehealthcare.com

4. How to Cancel a RAP

5. Cancelling a RAP (338 TOB) Overview • A RAP is submitted for each Medicare episode. Submitting a RAP posts the episode dates and the agency name to the CWF. • A RAP will be automatically cancelled in the system if the Final Claim is not received within the greater of 120 days from the start date of the episode or 60 days from the RAP payment date. The RAP payment is recouped at this point; however, the episode date and agency information remain in the CWF. You may immediately resubmit the RAP to receive payment again, and then follow up with submission of the Final Claim within 60 days of the new RAP payment. • A RAP is not a claim and cannot be “adjusted”. If it is discovered however, that there is erroneous information recorded on the RAP, the RAP can be cancelled. Corrections can be made and the RAP can be submitted again. • Cancellations will remove the episode dates and agency information from the CWF. • Resubmitting the RAP, places that information back into the CWF

6. Examples of Reason to Cancel a RAP • Incorrect Admission Date – admission date does not match the 1st billable visit date. • After the RAP was submitted on a recerted patient, a visit was inserted prior to the 1st billable visit after the recert start date, causing the 0023 Line Item Date for the HIPPS code to be incorrect. • The episode period was edited. • Patient demographics (name, DOB, gender) were edited.

7. How to cancel a RAP Step by Step Procedure • Select 03 (Claims Corrections) from the Main Menu in DDE and press ENTER • From the Claim and Attachment Corrections Menu, select 53 for Home Health Cancellations and press ENTER • Enter NPI and HIC# of claim you wish to cancel then enter the From and Thru dates of the claim. Press Enter. • On the Claim Summary Inquiry Screen, tab down to the claim you wish to cancel and type “S” in the “SEL” field next to the claim and press ENTER. • On page 1, arrow down to “condition code” and enter the Adjustment Condition Code D5 to indicate the reason for initiating the cancellation and press ENTER. • On page 3 of the claim, arrow down to the Adjustment Reason Code and type OT and press ENTER. • Go to page 4 and enter REMARKS to explain why claim is being cancelled. End REMARKS with your initials and the current date. • Press the F9 function key to UPDATE the cancellation to the Medicare System

8. Claim and Attachments Correction Menu Select 53 & hit ENTER

9. Claim Summary Inquiry Enter HIC#, NPI, From & Thru dates, press ENTER

10. Claim Summary Inquiry Type S in the SEL field to select the claim to cancel

11. Inst Claim Inquiry Arrow down to “Condition Codes” & enter Adjustment Condition Code D5, hit ENTER

12. Inst Claim Inquiry Arrow down to Adjustment Reason code, type OT & press ENTER

13. Inst Claim Inquiry Enter remarks stating why claim is being cancelled. End remarks with your initials. Hit F9 to update to Medicare

14. If Medicare payment is not what expected • You may have PEP’d an episode in your system but Medicare is not yet aware that the episode should be PEP’d. You may do a claim adjustment in DDE to PEP this episode. Medicare will then correct their payment and you’ll see the corrected payment on a future remittance. • Medicare may have PEP’d your claim due to an episode started by another agency but you have not PEP’d the episode in your system. • If the Early/Late episode timing question M0110 is not answered correctly in your OASIS, Medicare’s payment will not match your expected payment. In this circumstance, Medicare is correct and appropriate changes should be made in your system to correct this. • If you feel that Medicare has paid the incorrect amount, you can go to the Palmetto GBA website, choose your jurisdiction and check the HHA PPS Claims Calculator.

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