Submission of the Notice of Admission (NOA)

10.1.10.3 - Submission of the Notice of Admission (NOA) (Rev. 12577; Issued: 04-11-24, Effective:10-01-24; Implementation: 10-07-24) For each admission to home health, the HHA notifies Medicare systems via submission of a Notice of Admission (NOA). HHAs shall send the NOA to the A/B MAC (HHH) by mail, electronic data interchange (EDI), or direct data entry (DDE). EDI submissions require additional data not required by the NOA itself, to satisfy transaction standards. This data is described in a companion guide available on the CMS website. HHAs may voluntarily agree to adopt the companion guide and use it to submit EDI NOAs at any time. The HHA can submit an NOA to Medicare when: • The HHA has obtained a verbal or written order from the physician that contains the services required for the initial visit, and • The HHA has conducted an initial visit at the start of care. Only one NOA is required for any series of HH periods of care beginning with admission to home care and ending with discharge. After a discharge has been reported to Medicare, a new NOA is required before the HHA submits any additional claims. NOAs must be submitted timely. A timely-filed NOA is submitted to and accepted by the A/B MAC (HHH) within five calendar days after admission date. In instances where an NOA is not timely-filed, Medicare shall reduce the payment for a period of care, including outlier payment, by the number of days from the home health admission date to 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. If an HHA fails to file a timely-filed NOA, it may request an exception, which, if approved, waives the consequences of late filing. The four circumstances that may qualify the HHA for an exception are as follows: 1. fires, floods, earthquakes, or other unusual events that inflict extensive damage to the HHA’s ability to operate; 2. an event that produces a data filing problem due to a CMS or A/B MAC (HHH) systems issue that is beyond the control of the HHA; 3. a newly Medicare-certified HHA that is notified of that certification after the Medicare certification date, or which is awaiting its user ID from its A/B MAC (HHH); or, 4. other circumstances determined by the A/B MAC (HHH) or CMS to be beyond the control of the HHA. When an NOA is submitted within the five day timely filing period, but the NOA contains inadvertent errors (such as a beneficiary identifier that has recently changed), the error may not trigger the NOA to be immediately returned to the HHA for correction. In these instances, the HHA must wait until the incorrect information is fully processed by Medicare systems before the NOA is returned for correction. Such delays in Medicare systems could cause the NOA to be late. Delays due to Medicare system constraints are outside the control of the HHA and may qualify for an exception to the timely filing requirement. Medicare contractors shall grant an exception for the late NOA if the HHA is able to provide documentation showing: (1) When the original NOA was submitted; (2) When the NOA was returned for correction or was accepted and available for correction and; (3) Evidence the HHA resubmitted the returned NOA within two business days of when it was available for correction or cancelled an accepted NOA within two business days and submitted the new NOA within two business days after the date that the cancellation NOA finalized. The HHA shall provide sufficient information in the Remarks section of its claim to allow the contractor to research the case. If the remarks are not sufficient, Medicare contractors shall request documentation. Documentation should consist of printouts or screen images of any Medicare systems screens that contain the information shown above. HHAs can reduce the number of errors and exception requests related changes to the beneficiary identifier by performing an eligibility check immediately before admission. This can confirm that the Medicare Beneficiary Identifier (MBI) is active and accurate since the eligibility inquiry system contains an MBI End Date field. If there is a date in that field, the MBI is not valid after that date. The HHA can contact the beneficiary or use the MBI Lookup tool to determine the current MBI to use on the NOA. Since correct beneficiary identifier information is available to the HHA, only changes that occur shortly before the admission are beyond the HHA’s control. A/B MAC (HHH) MACs will not grant exceptions based on MBI changes that were accessible to the HHA more than two weeks prior to the admission date. An admission period will be opened on CWF with the receipt and processing of the NOA. NOAs are submitted using TOB 032A. After this admission period is recorded, the HHA can submit claims for HH periods of care in the admission. See section 40.1 for detailed submission instructions and required information for the NOA.