Home Health Billing

Correcting and Avoiding Reason Code 38157: Duplicate Request for Anticipated Payment

This edit is applied to claims when a RAP and final episode claim are submitted at the same time or when a RAP is submitted when there is one for the same episode already in the system.

Provider Action

  1. Verify the billing that is already in the system for the dates of service that need to be billed prior to submitting anything to Medicare. A RAP must be submitted and finalized in the claims processing system before the final episode claim can be submitted.A RAP usually takes 2-3 days to process through the system. Once an episode claim is submitted and processed, the RAP for the episode is canceled in the system.
  2. If the RAP in the system has incorrect information (e.g., wrong date of service, wrong HIPPS code), it should be corrected prior to submitting the episode claim. A RAP that has been submitted with incorrect information must be canceled and a RAP with the correct information should be submitted.
If... Then...
The RAP and claim were submitted
at the same time.		 Resubmit the RAP, wait for it to process (S/LOC PB9997), then submit the final episode claim.
The RAP was submitted with
incorrect information.		 Cancel the RAP, wait for the cancel to finalize (S/LOC PB9997), then submit a new RAP with the correct information.

 

How to Avoid This Reason Code

  • Always check the FISS or your remittance advices prior to submitting any new billing to Medicare to ensure there is no duplicate billing.
  • Develop an internal process or checklist of systems/information that must be confirmed before submitting claims to Medicare.

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