Replacing Home Health Requests for Anticipated Payment (RAPs) with a Notice of Admission (NOA) – Manual Instructions

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

CMS has posted a 3-page MLN Matters Number: MM12256 for Home Health Agencies (HHAs) who submit bills to Home Health & Hospice Medicare Administrative Contractors (HH&H MACs) for services they provide to Medicare patients.  This article tells you about updates to Chapter 10 of the Medicare Claims Processing Manual to include instructions for submitting Home Health (HH) NOAs instead of RAPs on and after January 1, 2022 … CR 12256.  Please make sure your billing staffs are aware of these manual updates.

Some of the highlights to look for as you review this MLN Matters and the Change Request document:

  • Starting January 1, 2022, Medicare will require to submit a one-time NOA, instead of RAPs.
  • To submit an NOA, you must have a verbal or written order from the physician that contains the services required for the initial visit. You must have conducted an initial visit at the start of care.
  • For all patients receiving HH services in 2021 whose services will continue in 2022, you should submit an NOA with a one-time, artificial “admission” date corresponding to the “From” date of the first period of continuing care in 2022.
  • CMS only requires 1 NOA for any series of HH POCs beginning with admission to home care and ending with discharge. Once you report a discharge to Medicare, you must send a new NOA before you submit any additional claims.
  • HHAs must submit an NOA to their MAC within 5 calendar days from the start of care date. The NOA is a one-time submission that establishes the HH POC and covers contiguous 30-day POCs until you discharge the individual from Medicare HH services.
  • There will be a non-timely submission reduction in payment amount tied to any late NOA submissions when you don’t submit the NOA within 5 calendar days from the start of care. The reduction in payment amount would be equal to a 1/30th reduction to the wage adjusted, 30-day period payment amount for each day from the HH start of care date until the date you submit the NOA.