Notice of admission (NOA)

The NOA is the front door to Medicare home health billing. When the agency admits a patient, it sends the notice to its Medicare Administrative Contractor with the patient’s Medicare identifiers, the admission date and the agency’s identifiers. Once the contractor accepts it, Medicare’s systems associate the patient with that agency for the admission, and the agency’s claims for the periods of care that follow can process. It is submitted through the same institutional channels the agency uses for its claims, and it is a notice, not a claim: it carries no charges and pays nothing by itself.

Timing is the whole point. CMS sets a deadline for the NOA counted from the start of care, and a late NOA reduces the payment for the period, with the reduction tied to how late it was. An NOA with a wrong admission date, a wrong Medicare number or a patient already admitted elsewhere rejects, and the days keep counting while you fix it. Agencies that bill monthly see the NOA problem only when the first claim returns, by which point the window is long closed.

The mistake is treating the NOA as a billing task rather than an intake task. Build it into admission: submit on the day of the first visit, confirm acceptance on the contractor’s system, and keep the acceptance record with the chart. When the delay was outside the agency’s control, request an exception under the conditions CMS publishes rather than accepting the reduction.