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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. 
 
The rules say that providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that for all beneficiaries receiving home health (HH) services in 2021 whose services will 
continue in 2022, the home health agency (HHA) shall submit an Notice of Admission (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. HHAs 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. 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. 
 
You can find this information in the Medicare Claims Processing Manual Chapter 10 - Home Health Agency 
Billing, 10.1.10.3 - Submission of the Notice of Admission, 40.1 - Notice of Admission (NOA) and 40.2 - HH 
PPS Claims. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.