RAP (Request for Anticipated Payment)

Under the original home health prospective payment system, Medicare split each episode's payment into two pieces. The agency filed a RAP at the start of the episode and received a substantial advance, originally 60 percent of the expected payment for an initial episode and 50 percent for subsequent episodes, with the remainder paid on the final claim. The design recognized that home health agencies carry significant upfront costs, assessment, care planning, and early intensive visits, long before a final claim could be billed. For two decades the RAP was the cash-flow backbone of home health billing.

CMS unwound RAP payments in stages, citing program integrity: bad actors had collected RAP advances and disappeared without ever filing final claims. Newly enrolled agencies stopped receiving RAP payments first. Then, for calendar year 2021, RAP payments dropped to zero for all agencies, but agencies still had to file a no-pay RAP within 5 calendar days of the start of each 30-day period, with a payment reduction of one-thirtieth per day for late filing. That no-pay RAP year was effectively a dress rehearsal for what came next: on January 1, 2022, the RAP was retired entirely and replaced by the one-time NOA.

The two mechanisms differ in both money and frequency. The RAP carried an advance payment for most of its life; the NOA never pays anything and exists purely to establish the admission in Medicare's systems. The RAP was filed for every payment period; the NOA is filed once per admission and covers all subsequent periods until discharge. What carried over is the deadline discipline: the 5-calendar-day window and the per-day payment penalty for lateness moved from the 2021 no-pay RAP directly into the NOA. Agencies that built strong RAP timeliness processes in 2021 generally transitioned smoothly.

RAP persists in home health vocabulary and systems. Veteran billers and consultants still say RAP when they mean the NOA, legacy reports and policies reference RAP timeliness, and old accounts receivable, appeals, or audit lookbacks can involve claims from the RAP era. Anyone reconciling pre-2022 payment history needs to understand the split-payment mechanics to interpret remittances from that time. For current operations, though, the actionable requirement is the NOA: one submission per admission, 5 calendar days, daily monitoring for rejections.