Updated on 01/25/2021

Home health agencies (HHAs) have had requests for anticipated payments (RAPs) retuned to providers (RTP’d) related to value code 61. With the no pay RAP policy, effective January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) is no longer requiring that HHAs 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, HHAs 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, The MACs 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.

 

 

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Information provided by CMS on December 28, 2020