The Core Function of the Notice of Admission (NOA)
The Notice of Admission (NOA), implemented in 2022, is a key part of the Medicare home health payment system. It serves as the official communication from a Home Health Agency (HHA) to the Medicare Administrative Contractor (MAC), indicating a patient's admission for care and that the HHA is the designated provider. This single notification replaced the need for multiple Requests for Anticipated Payment (RAPs) per 30-day episode, simplifying administration. The NOA registers the patient in the Common Working File (CWF) and remains active until the patient is discharged.
Key Purpose of the Notice of Admission
- Establishes Care: The NOA formally registers the patient's home health care with Medicare.
- Replaces RAPs: It eliminates the need for recurring RAP submissions.
- Initiates Billing: The NOA starts the first of potentially several 30-day billing periods.
- Ensures Reimbursement: Timely submission is crucial for full Medicare payment, as late filings incur penalties.
Requirements for a Valid NOA Submission
For a home health agency to submit a valid Notice of Admission, two main conditions must be met to avoid financial penalties.
Conditions for Submission
- Physician's Order: A valid written or verbal physician's order for the initial visit services is required.
- Initial Visit Completed: The first patient visit must be completed, confirming care has begun.
The Critical 5-Day Deadline
The NOA must be submitted within five calendar days of the patient's start of care. Late submissions result in a payment reduction of 1/30th of the 30-day period payment for each late day. This penalty is the agency's responsibility.
The NOA's Role in Ongoing Care and Discharge
The initial NOA is foundational for the entire episode of care.
Subsequent Periods of Care
- No Additional NOAs: A single NOA covers all continuous 30-day periods with the same agency.
- Discharge and Readmission: The NOA becomes invalid upon discharge. A new NOA is needed if the patient requires home health services again.
The Importance of Patient Discharge
Properly discharging a patient is vital. Submitting a discharge notice ends the active NOA and allows for final claims. This prevents issues if the patient seeks care elsewhere or is readmitted.
Notice of Admission vs. Other Healthcare Notifications
Understanding the different types of notices is important.
| Feature | Notice of Admission (NOA) | Notice of Eligibility/Action | Admission Agreement | Patient Rights Notification |
|---|---|---|---|---|
| Purpose | Informs Medicare of a patient's start of home health care for billing. | Informs a beneficiary of their eligibility for a program. | Contract between a facility and a resident outlining terms. | Informs a patient of their legal rights upon admission. |
| Who Submits | Home Health Agency (HHA) to a Medicare Administrative Contractor (MAC). | State or local government agency to the beneficiary. | Senior care facility to the resident. | Facility to the resident/patient. |
| Recipients | Medicare, via MAC. | Beneficiary/Patient. | Resident/Patient. | Resident/Patient and sometimes family/representative. |
| Timeline | Within 5 calendar days of the start of home health care. | Varies by program. | At the time of or as a condition of admission. | Upon admission to the healthcare facility. |
Exceptions to Timely Filing
CMS allows for exceptions to the five-day deadline under specific circumstances to avoid payment penalties. These include:
- Major disasters disrupting operations.
- Data filing problems with CMS or the MAC.
- Newly certified HHAs awaiting necessary information.
- Other circumstances beyond the provider's control.
The Shift from RAP to NOA: A Historical Context
The NOA replaced the Request for Anticipated Payment (RAP) system used before January 1, 2022. RAPs were required for each 30-day episode, creating a repetitive administrative process. The NOA streamlined this by requiring only one submission per episode under the Patient-Driven Groupings Model (PDGM). This change also removed the need for diagnosis and HIPPS codes with the initial notification. For more details on CMS regulations, refer to the official CMS Manual System.
Conclusion
Understanding what is a notice of admission is crucial for those involved in senior home health care. It is a vital procedural step that confirms a patient’s start of care and initiates Medicare billing. Timely and accurate NOA submissions are essential for agencies to receive proper reimbursement and for patients and families to ensure their care is correctly registered.
