Submission of the Notice of Admission (NOA)

10.4 - Submission of the Notice of Admission (NOA) (Rev. 11447, Issued: 06-06-22, Effective: 01-01-22, Implementation: 05-26-22) Beginning January 1, 2022, HHAs will no longer submit Requests for Anticipated Payment (RAPs). Instead, for each admission to home health, the HHA notifies Medicare systems via submission of an NOA. The NOA is a one-time submission to establish that the beneficiary is under a home health period of care and trigger home health consolidated billing edits. The NOA covers contiguous 30-day periods of care until the individual is discharged from Medicare home health services. There is no upfront payment with the submission of the NOA. The NOA must be submitted timely. All HHAs must submit an NOA to their Medicare contractor within 5 calendar days from the start of care date to establish that the beneficiary is under a Medicare home health period of care and also to trigger home health consolidated billing edits required under section 1842(b)(6)(F) of the Act. For example, if the start of care date is January 1, 2022, the NOA would be considered timely-filed if it is submitted on or before January 6, 2022. Example: 1/1/2022 = Day 0 (start of the first 30- day period of care) 1/6/2022 = Day 5 (An NOA submitted on or before this date would be considered ‘‘timely-filed’’.) 1/7/2022 and after = Day 6 and beyond (An NOA submitted on and after this date would be considered untimely and would trigger the penalty.) In instances where an NOA is not timely-filed, Medicare shall reduce the payment for a period of care, including outlier payments, by the number of days from the home health admission date until the date the NOA is submitted to, and accepted by, the A/B MAC (HHH), divided by 30. No LUPA per-visit payments shall be made for visits that occurred on days that fall within the period of care prior to the submission of the NOA. This reduction shall be a provider liability, and the provider shall not bill the beneficiary for it. CMS may waive the consequences of failure to submit a timely-filed NOA if it is determined that a circumstance encountered by a home health agency is exceptional and qualifies for waiver of the consequence. An exceptional circumstance may be due to, but is not limited to the following: • Fires, floods, earthquakes, or similar unusual events that inflict extensive damage to the home health agency’s ability to operate. • A CMS or Medicare contractor systems issue that is beyond the control of the home health agency. • A newly Medicare-certified home health agency that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its Medicare contractor. • Other situations determined by CMS to be beyond the control of the home health agency. If an HHA believes that there is a circumstance that may qualify for an exception, the HHA must fully document and furnish any requested documentation to their MAC for a determination of exception. See Pub. 100-04, Medicare Claims Processing Manual, Chapter 10, “Home Health Agency Billing” for requirements regarding the notice of admission process.