Payer Changes and the 5 Day RAP - Important Focus for January 2021

Like always, the new year brings numerous payer changes for patients receiving home health.

When making Payer changes, please keep in mind that a Payer change from a Medicare or Medicare Advantage plan as the Primary payer will always require a discharge. A new SOC Admit must be started for the new Payer.

Due to the new 5-day RAP rule that went into effect 1/1/2021, addressing payor changes timely is critical to ensure RAPS are processed and accepted within the 5 day window.

Even when the patient is moving from Medicare or Medicare Advantage to a commercial or Medicaid policy as Primary, the Medicare or Medicare Advantage account will need to be discharged, and a new SOC Admit started for the commercial insurance/Medicaid plan.

The only time a discharge is not required is when the patient changes from a Commercial Insurance or Medicaid policy to another commercial Insurance or Medicaid policy.