Notice of Admission (NOA) in 2024

Navigating the intricacies of healthcare billing often poses challenges. Understanding the Home Health NOA is essential for any home health agency (HHA). This replaced the previous system of requesting anticipated payments (RAPs) and has significantly impacted how HHAs bill for and receive payment for services.

We’re here to streamline the process, provide expert guidance and services for your home health, hospice, or palliative care business.

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Three major benefits of NOA services

Our experience has equipped our expert team with the knowledge and tools to handle all the major issues associated with NOA’s.

Automated Data Entry

Our team works in your EHR to meet the NOA requirements. Let our team submit and track NOAs to prevent penalties and ensure timeliness.

Streamlined Processing

MACs frequently encounter difficulty with processing and status updates. Our seasoned experts efficiently and smoothly streamline all processing for rebilling.

No Lost Data

All too often, agencies find themselves facing problems with missing data. These issues significantly add to their workload, and jeopardize their success. HealthRev ensures all required data is gathered and submitted to prevent any interruptions throughout the process.

How to be prepared for NOA’s in 2024

Here’s everything that you need to know to be prepared including:

  • What the Notice of Admission (NOA) is and what it does
  • Who submits the NOA and when it’s submitted
  • The benefits of the NOA for both HHAs and Medicare
  • Additional resources and tips for accurate and efficient NOA submission

By the end of this guide, you will be well-equipped to navigate the NOA process and ensure your HHA is compliant with all Medicare regulations.

What Is A Notice Of Admission (NOA)?

A Notice of Admission or NOA is a one-time notification for a series of home health periods of care (HH POCs). It is basically an extension of the no-pay RAPs, which goes back to the reduced RAPs that started back in 2020.

Only one NOA is required for a series of HH POCs. It must be submitted at the beginning of the first 30-day payment episode, within five days of the start of care. The NOA establishes the patient and remains active until a discharge is submitted for that patient. However, once a discharge is submitted to Medicare, a home health agency must submit a new NOA in order to send and receive payment for any additional claims.

What Is Needed To Submit A NOA?

The NOA can be submitted with just two pieces of information.

  1. A written or verbal doctor’s order that identifies the skills necessary for the first visit. We suggest ensuring the physician is PECOS enrolled to prevent the possibility of denial of the claim.
  2. Complete the first visit.

The NOA eliminates the need to submit a valid diagnosis code and HIPSS code.

What If Medicare Isn’t The Primary Insurance?

Even if Medicare isn’t the patient’s primary insurance, we recommend that you still send a NOA. Our rule of thumb is to always submit the NOA so that it is on file with Medicare. In that case, if the payer is changed, we’ve already established care with Medicare and can release the final claim.

Note that if Medicare does become primary, best practice is to discharge the patient and readmit under Medicare to ensure compliance with Medicare guidelines.

How Do I Submit A NOA?

NOAs can be sent to your MAC by mail, Electronic Data Interchange (EDI), or through the Direct Data Entry (DDE) system. For more information specific to your MAC, please visit their website.

CR 12256 adds new information to Chapter 10 of the Medicare Claims Processing Manual, including detailed NOA filing procedures and amended billing instructions.

What Type Of Bill (TOB) Will Be Required?

NOAs should be sent using a TOB 32A. Use TOB 329 for Periods of Care (POCs) after you submit the NOA. According to CMS, “the National Uniform Billing Committee (NUBC) has redefined TOB 329 to represent an original claim, rather than an adjustment, for all claims with “From” dates on or after January 1st, 2022.”

What If We Miss The 5-Day Submission Deadline?

Your agency will need to manually enter the NOA into the DDE system when you notice that the NOA is not on file with Medicare. If you do not submit your NOA within 5 calendar days of the commencement of care, you will be charged a non-timely submission fee.

The payment amount will be reduced by 1/30th of the wage-adjusted, 30-day period payment amount for each day that it’s late, counting from the start of care date to the date the NOA is submitted or the patient was discharged if an NOA is not submitted.

Can I File An Exception Request If I Miss The 5-Day Submission Deadline?

Yes, the exception will be added on the final claim as a conditional request. However, late NOA submission does not automatically approve you for an exception. There must be a valid reason the exception is being requested based on Medicare late submission criteria. If you fail to timely file the NOA, you may request an exception. If approved, the late submission fee will be waived. The four circumstances that may qualify for an exception are listed on these manual instructions.

Additional Resources And Tips

To ensure accurate and efficient NOA submission, HHAs can access valuable resources and follow these helpful tips:

CMS Home Health NOA Overview: This official document provides comprehensive information about the NOA, including its purpose, requirements, and submission process.

Palmetto GBA NOA FAQs: This frequently asked questions document addresses common concerns and clarifications regarding the NOA.

Ensuring NOA Accuracy and Efficiency: HHAs can further enhance their NOA submission process by:

  • Completing thorough training for staff involved in NOA submission.
  • Implementing robust quality control measures to ensure data accuracy.
  • Partnering with a reliable RCM provider for expert support and guidance.

Please make sure that your billing department is up to date on these manual changes.

How Can A Reliable RCM Partner Help?

HealthRev Partners provides the expertise to ensure the agency has a NOA and the submission process is completed timely.

Our team checks for errors or any inconsistencies in the NOA data, reducing the risk of rejections and denials. Our team of expert RCM specialists stays informed about evolving NOA regulations and best practices, offering agencies up-to-date information and support in complying with changing requirements.

The History Of RAPs And NOAs

When CMS implemented the No-Pay RAP in January 2021, home health agencies experienced significant change related to cash flow. Most notably, after transitioning from 60% of the anticipated payment upfront to 20% in 2020, upfront payments were completely phased out in 2021. This put many agencies in a bind because they no longer received cash upfront to cover the cost of care. Agencies also experienced penalties from late submissions.

Another change was that agencies were required to submit a No-Pay RAP for each 30-day period of care. However, if an agency knew that a patient would continue care into a second 30-day period, they could submit both RAPs at the same time. At this time, the billing team at HealthRev Partners is billing both RAPs at the same time.

CMS initially intended to replace No-Pay RAPs with NOAs in January 2021, and the details were part of the Final Rule for Home Health PPS released in 2020. However, the transition was postponed due to comments submitted by stakeholders within the industry. Your comments matter! Learn more about how you can influence CMS policies. 

NOAs went into effect January 1, 2022. The NOA eliminates submitting No-Pay RAPs.

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