Billing the Home Health Notice of Admission Electronically
Table of Contents
- Billing the Home Health Notice of Admission Electronically
- NOA Claim Page 1
- NOA Claim Page 2
- NOA Claim Page 3
- NOA Claim Page 4
- NOA Claim Page 5
- Related Content
Billing the Home Health Notice of Admission Electronically
Any codes within this job aid indicate common codes for required fields on Home Health NOAs. The NUBC maintains the coding information for Medicare billing, including the UB-04 data elements. For an all-inclusive listing of codes appropriate for all claim fields used for Medicare billing, visit the NUBC website to subscribe to the Official UB-04 Data Specifications Manual.
The bolded fields on the claim screen shots provided are the fields required when billing the Home Health NOA via the 837I format (electronically). The tables below the screen shots include field title descriptions and the associated valid values.
NOA Claim Page 1
| Field | Description/Notes |
|---|---|
| MID Medicare ID Number |
Enter the Medicare Beneficiary Identifier |
| TOB Type of Bill |
32A – Notice of Admission 32D – Cancellation of Admission |
| NPI National Provider Identifier Number |
Enter your home health agency’s NPI number. |
| STMT DATES FROM and TO (Statement Covers Period "From and "Through") | Report the date of the first visit provided in the admission as the From date. The To or Through date on the NOA must always match the From date. |
| LAST, FIRST, MI, ADDR, DOB, SEX | Patient’s last name, first name, and middle initial (if applicable), full address, date of birth (MMDDYYYY) and sex code (M/F) |
| ADMIT DATE | Enter the effective date of admission, which is the first Medicare billable visit and the Medicare start of care date (MMDDYY). The Admission date on the NOA must always match the From date. |
| SRC Source of Admission |
Submit a default value of "1." |
| STAT Patient Status |
Submit default value of "30". |
| COND CODES Condition Codes |
Enter condition code 47 for a patient transferred from another HHA. HHAs can also use cc 47 when the patient has been discharged from another HHA, but the discharge claim has not been submitted or processed at the time of the new admission. |
| FAC. ZIP | Facility ZIP Code of the provider or subpart (9 digit code). |
NOA Claim Page 2
| Field | Description/Notes |
|---|---|
| REV Revenue Codes |
Enter Revenue Code 0023, which indicates billing under HH PPS. |
| HCPC Healthcare Common Procedure Code |
Submit HIPPS code 1AA11 as a placeholder value, since differing HIPPS codes may apply over the course of an HH admission. |
| TOT UNITS Total Services Units |
Enter 1 unit |
| TOT CHARGE Total Charge |
The total charge for the 0023 revenue line must be zero. |
| SERV DT Service Date |
Must not be a future date. The admission date may be duplicated to satisfy this requirement. |
NOA Claim Page 3
| Field | Description/Notes |
|---|---|
| PAYER Payer Identification |
Enter “Medicare” on line A with payer code “Z.” |
| RI Release of Information |
Enter “Y”, “R” or ‘’N” “Y” – Indicates the HHA has a signed statement on file permitting it to release data to other organizations in order to adjudicate claims “R” – Indicates the release is limited or restricted “N” – Indicates no release is on file |
| DIAGNOSIS CODES | Enter the appropriate ICD code for the principal diagnosis code or submit any valid diagnosis code. |
| ATT PHYS Attending Physician |
Enter the NPI and name (last name, first name, middle initial) of the attending physician who established the plan of care with verbal orders – this must be the individual physician’s NPI, not a group NPI. |
NOA Claim Page 4
| Field | Description/Notes |
|---|---|
| REMARKS | Remarks are not required on the NOA; however, remarks are recommended when canceling the NOA to indicate the reason for cancellation. |
NOA Claim Page 5
| Field | Description/Notes |
|---|---|
| INSURED NAME | Enter the patient’s name as shown on the Medicare card. |
| CERT/SSN/HIC | Enter the beneficiary’s Medicare number as it appears on the Medicare card if it does not automatically populate. |
Notes:
- Required for any period of care that starts on or after 1/1/2022
- HHAs with periods of care that continue into 2022 from 2021 need to submit an NOA with a one-time artificial admission date that corresponds with the ‘From’ of the new period of care in 2022
- HHAs are to submit the NOA when they have received the appropriate physician’s written or verbal order that contains the services required for an initial visit, and the HHA has conducted the initial visit at the start of care
- NOA must be submitted within five calendar days from the start of care. A payment reduction applies if an HHA does not submit the NOA within this timeframe.
- 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 home health start of care date until the date the HHA submitted the NOA
Patients Continuing Care in 2022
HHAs with periods of care that continue from 2021 into 2022 must submit a NOA with a one-time artificial admission date that corresponds with the “From” on the new period of care in 2022.
For example, if the start of care is 12/13/2021, the first 30-day period of care runs from 12/13/2021 – 01/11/2022. The NOA date needs to be 1/12/2022 for the new period beginning in CY2022.
- The reduction would include any outlier payment
- The reduction amount will be displayed with value code QF on the claim
- Start of Care: 12/13/2021
- 30-day period of care: 12/13/2021 – 1/11/2022
- Submit an NOA with an admission date of 1/12/2022 for the next 30-day period of care, and any subsequent period(s) of care until the patient is discharged
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 10
- MLN Matters® Article: MM12256: Replacing Home Health Requests for Anticipated Payment (RAPs) With a Notice of Admission (NOA) – Manual Instructions
- CR12227: Replacing Home Health Requests for Anticipated Payment (RAPs) with a Notice of Admission – Implementation
- CMS 837I NOA Companion Guide
Reviewed 5/20/2024