Situation Report | January 25, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) recently announced a “Workaround” for certified home health agencies (CHHAs) that have had requests for anticipated payments (RAPs) “returned to provider” (RTP’d) related to value code 61.
Beginning with the no-pay RAP policy, on January 1, 2021, CMS is no longer requiring that CHHAs report value code 61 and the core-based statistical area (CBSA) on RAPs. However, an error in the Medicare claims processing system is not processing RAPs that do not include value code 61.
While the Medicare Administrative Contractors (MACs) were waiting for a system fix, CHHAs were instructed to continue to report value code 61 and the CBSA on RAPs even though this code is optional.
The MACs have recently received instructions from CMS to implement a workaround. Claims receiving reason code 32035 will suspend (S status code), rather than RTP. Once suspended, MACs, like National Government Services (NGS), will add value code 61 and a placeholder CBSA code 10180 to the RAP, so it can continue to process.
Due to the instructions received from CMS, there is no longer a need for providers to report value code 61 and the CBSA, and no further action is required for providers.