Reason Code 37364

Subject

The Notice of Admission (NOA) receipt date is beyond the claim’s ‘Through’ date for the billing period, applying a late NOA payment penalty for all days billed.

NOAs must be submitted timely. A timely filed NOA is submitted to and accepted by the Jurisdiction A/Jurisdiction B Medicare Administrative Contractor (A/B MAC) (Home Health and Hospice (HHH)) within five calendar days after admission date. The term 'Accepted' is defined as processing and approving after the NOA is received. The date a NOA completes processing and approves is not used in calculating the NOA’s timeliness, only the date the NOA was received by the MAC.

In instances where a 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 Low Utilization Payment Adjustment (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.

Description

The NOA receipt date is 30 or more days from the claim from date on type of bill 32x (excluding 32a, 322 or 320), indicating the NOA was late. NOAs received after day 5 will automatically receive a reduction in pay from the billing period. A late NOA exception was not submitted, incorrectly/impartially submitted or the exception request was denied on the claim. No provider reimbursement can be issued. Please see Palmetto GBA's article Late Notice of Admission: The Exception Process. This reason code also applies to late submitted Home Health (HH) Resident Assessment Protocols (RAPs) on or before 12/31/2021.

Resolution

If a home health agency (HHA) fails to file a timely-filed NOA, it may request an exception on the period of care claim(s), 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 HHA’s ability to operate;
2. An event that produces a data filing problem due to a Centers for Medicare & Medicaid Services (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.

If an HHA did not file an exception request or filed an incorrectly/impartially submitted exception on the claim, they may adjust the claim and request an exception. To request an exception the HHA shall append modifier KX to the Health Insurance Prospective Payment System (HIPPS) code reported on the 0023 revenue code line. The HHA shall also provide sufficient information in the 'Remarks' section of the claim to allow the contractor to research the case. If the remarks are not sufficient, the MAC may return the claim for more information. 

Condition code (CC) 47 is required on NOAs in HH transfer situations and should also be used when the beneficiary has been discharged from another HHA, but their period of care claim has not been submitted or processed at the time of the new admission to discharge the beneficiary. If CC 47 is not applied to the NOA in these scenarios, the NOA will return for reason code U537F (the NOA admission date falls within an existing home health admission period for another HHA). In most cases this would make the NOA late and an exception may not be granted if the other HHA’s admission was on the beneficiary’s eligibility file when the NOA was initially submitted.

Medicare contractors shall not grant exceptions if:

• The HHA made no attempt to submit the NOA timely and did not meet any of the four circumstances that may qualify for an exception;
• The HHA can correct the NOA without waiting for Medicare systems actions;
• The HHA submits a partial NOA to fulfill the timely filing requirement; or
• An HHA with multiple provider identifiers submits the identifier of a location that did not actually provide the service.

If the reason the NOA was late does not qualify for an exception, no provider reimbursement can be issued for the claim. 

Late NOAs Due to MBI Changes

Effective for NOAs on January 1, 2024, A/B MACs will not grant exceptions based on MBI changes that were accessible to the HHA more than two weeks prior to the admission date. Since current beneficiary identifier information is available to HHAs in eServices’ Medicare Beneficiary Identifier (MBI) Lookup tab or another MAC's provider portal, only changes that occur shortly before the admission are beyond the HHA control.

References

• CMS Internet-Only Manuals (IOMs), Pub. 100-04, Medicare Claims Processing Manual, Chapter 10 - Home Health Agency Billing, Section 10.1.10.3 - Submission of the Notice of Admission (NOA) (PDF)
• Late Notice of Admission: The Exception Process
• Home Health Notice of Admission (NOA) Frequently Asked Questions (FAQ) (PDF)
• Home Health and Hospice Billing When a New Medicare Beneficiary Identifier Is Assigned