Situation Report | June 1, 2021
The U.S. Centers for Medicare and Medicaid Services (CMS) has recently issued Change Request (CR) 12256 on Replacing Home Health Requests for Anticipated Payment (RAPs) with the Notice of Admission (NOA).
Effective January 1, 2022, the CR updates multiple sections of Chapter 10 of the Medicare Claims Processing Manual to reflect requirements for the Patient Driven Groupings Model (PDGM) such as adding “Notice of Admission” when applicable and replacing the phrase “60-day episode/30-day periods” with “30-day period” throughout the Manual chapter.
Starting in 2022, providers must submit NOAs in place of the current no-pay RAP requirement. The NOA has the same submission criteria as the no-pay RAP but requires different elements to be reported. Section 40.1 in chapter 10 has been revised to outline the NOA requirements, along with section 40.2 on the impact of the NOA for claims processing.
Home health agencies (HHAs) must submit the NOA to the Medicare Administrative Contractor by mail, electronic data interchange (EDI) or direct data entry (DDE). However, EDI submissions require more information on the NOA to satisfy transaction standards (such as line-item service information and primary diagnosis) than what is required by the Medicare program for the other submission modes.
HHAs using EDI for the NOA submission should review the 837 companion guide on the CMS website.
CMS also provides more specific instructions in section 10.1.19-Applying OASIS assessment Items to Determine HIPPS Code on ensuring the Outcome and Assessment Information Set (OASIS) and the claim match, and when it is appropriate to re-submit a claim related to OASIS and claim matching errors.