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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Medicare Guidance Says The episode or period of care is the unit of payment for HH PPS. The episode/period 
of care payment is specific to one individual homebound beneficiary. It pays all Medicare covered home care 
that is reasonable and necessary for the patients care, including routine and nonroutine supplies used by that 
beneficiary during the episode/period of care. It is the only Medicare form of payment for such services, with 
the exceptions described in Section 10.B. 
10.1.10 - Provider Billing Process Under HH PPS 
The next four sections describe the basic HH PPS billing process, not including payment adjustments. Payment 
adjustment follows in subsequent sections. 
 
10.1.10.3 - Submission of the Notice of Admission (NOA) 
 
HHAs shall no longer submit Requests for Anticipated Payment (RAPS -TOB 0322) for any HH period of care 
with a From date on or after January 1, 2022. Instead, for each admission to home health, the HHA notifies 
Medicare systems via submission of an NOA. HHAs shall send the NOA to the A/B MAC (HHH) by mail, 
electronic data interchange (EDI), or direct data entry (DDE). EDI submissions require additional data not 
required by the NOA itself, to satisfy transaction standards. This data is described in a companion guide 
available on the CMS website. HHAs may voluntarily agree to adopt the companion guide and use it to submit 
EDI NOAs at any time. For all beneficiaries receiving HH services in 2021 whose services will continue in 
2022, the HHA shall submit an NOA with a one-time, artificial 'admission' date corresponding to the "From" 
date of the first period of continuing care in 2022. For example, if a period of care begins in 2021 and ends on 
January 10, 2022, the HHA submits and NOA with an admission date of January 11, 2022, and then submits a 
claim when the 30-day period of care is over. The HHA should submit the January 11, 2022, admission date on 
all subsequent claims until the beneficiary is discharged and another NOA is required. This is to ensure the 
claim is matched to the correct NOA and the correct receipt date is used for payment. 
The HHA can submit an NOA to Medicare when: 
The HHA has obtained a verbal or written order from the physician that contains the services required for the 
initial visit, and The HHA has conducted an initial visit at the start of care. 
Only one NOA is required for any series of HH periods of care beginning with admission to home care and 
ending with discharge. After a discharge has been reported to Medicare, a new NOA is required before the HHA submits any additional claims. NOAs must be submitted timely. A timely-filed NOA is submitted to and 
accepted by the A/B MAC (HHH) within five calendar days after admission date. In instances where an NOA 
is not timely-filed, Medicare shall reduce the payment for a period of care, including outlier payment, by the 
number of days from the home health admission date to the date the NOA is submitted to, and accepted by, the 
A/B MAC (HHH), divided by 30. No LUPA per-visit payments shall be made for visits that occurred on days 
that fall within the period of care prior to the submission of the NOA. 
This reduction shall be a provider liability, and the provider shall not bill the beneficiary for it. If an HHA fails 
to file a timely-filed NOA, it may request an exception, which, if approved, waives the consequences of late 
filing. The four circumstances that may qualify the HHA for an exception are as follows: 
1. fires, floods, earthquakes, or other unusual events that inflict extensive damage to the HHAs ability to 
operate; 
2. an event that produces a data filing problem due to a CMS or A/B MAC (HHH) systems issue that is beyond 
the control of the HHA; 
3. a newly Medicare-certified HHA that is notified of that certification after the Medicare certification date, or 
which is awaiting its user ID from its A/B MAC (HHH); or, 
4. other circumstances determined by the A/B MAC (HHH) or CMS to be beyond the control of the HHA. 
 
When an NOA is submitted within the five day timely filing period, but the NOA contains inadvertent errors 
(such as a beneficiary identifier that has recently changed), the error may not trigger the NOA to be 
immediately returned to the HHA for correction. In these instances, the hospice must wait until the incorrect 
information is fully processed by Medicare systems before the NOA is returned to the hospice for correction. 
Such delays in Medicare systems could cause the NOA to be late. Delays due to Medicare system constraints 
are outside the control of the hospice and may qualify for an exception to the timely filing requirement. An 
admission period will be opened on CWF with the receipt and processing of the NOA. NOAs are submitted 
using TOB 032A. After this admission period is recorded, the HHA can submit claims for HH periods of care 
in the admission. See section 40.1 for detailed submission instructions and required information for the NOA. 
10.1.10.4 - Claim Submission and Processing 
Payment due to an HHA for a period of care will be made based on a claim submitted at the end of the 30-day 
period, or after the patient is discharged, whichever is earlier. HHAs may not submit this claim until after all 
services are provided for the period and the physician has signed the plan of care and any subsequent verbal 
order. All HH PPS claims must be submitted with TOB 0329. The HH PPS claim will include line item detail 
describing all the services provided in the period of care. 
40.1 - Notice of Admission (NOA) 
HAs must send the NOA to the A/B MAC (HHH) by mail, electronic data interchange (EDI), or direct data 
entry (DDE). EDI submissions require additional data not required by the NOA itself, to satisfy transaction 
standards. This data is described in a companion guide available on the CMS website. HHAs may voluntarily 
agree to adopt the companion guide and use it to submit EDI NOAs at any time. Required - The Admission 
date on the NOA must always match the From date. 
40.2  HH PPS Claims 
The following data elements are required to submit a claim under home health PPS. For billing of home health 
claims not under an HH plan of care (not under HH PPS), see 90. Home health services under a plan of care 
are paid based on a 30-day period of care. HHAs submit an NOA at the beginning of an admission and then 
submit one claim for each 30-day period of care. Claims submitted before an NOA has been received for the 
beneficiary will be returned to the provider. In the great majority of cases, the five day timely filing period 
allows enough time to submit NOAs on a day when Medicare systems are available (i.e. the period allows for 
("dark days"). Additionally, the receipt date is typically applied to the NOA immediately upon submission to 
Medicare systems, so subsequent dark days would not affect the determination of timeliness. However, if the 
HHA can provide documentation showing an NOA is submitted on the day before a dark day period and the 
NOA does not receive a receipt date until the day following the dark days, the contractor shall grant an 
exception to the timely filing requirement. CMS expects these cases to be very rare. You can find this 
information in the Medicare Claims Processing Manual, Chapter 10  Home Health Agency Billing, Section 
10.1  Home Health Prospective Payment System (HH PPS) Sub Section 10.1.4  The HH PPS  Unit of Payment, Section 10.1.10  Provider Billing Process Under HH PPS, Section 10.1.10.3  Submission of Notice 
of Admission (NOA), Section 10.1.10.4  Claims Submission and Processing, Section 40.1  Notice of 
Admission (NOA) and Section 40.2 HH PPS Claims, CMS 837I NOA Companion Guide, and MM12256 
(cms.gov). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.