CMS Issues Additional Home Health Claim Processing Instructions

Posted Sunday, September 19, 2021

The Centers for Medicare & Medicaid Services (CMS) has issued Change Request 12424 that provides additional instructions related claims processing for the notice of admission (NOA) for claims that span calendar years 2021 and 2022, and special circumstances for discharges when no visits are made in a subsequent 30 day period.

In the Medicare Claims Processing Manual, chapter 10, Section – Submission of the Notice of Admission (NOA) has been revived to read:

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.

Section 40.2 – HH PPS Claims, in the manual has been revised to read:

Patient discharge status


In cases where an HHA provides care in a 30-day period of care and then discharges the beneficiary in the next 30-day period of care but does not provide any billable visits in the next 30-day period, special handling of the patient status code may be needed. Normally, the patient status code for 30-day period before the discharge would be thirty since the beneficiary has not yet been discharged. However, since there will not be a claim for the period in which the discharge occurred, this would result in the HH admission period remaining open in Medicare systems and prevent billing for any later HH services.

To close the HH admission period in these cases, the HHA should report patient status 01 on the claim for the last 30-day period in which visits occurred. This will trigger Medicare systems to close the HH admission period. If the claim has been submitted with patient status thirty before the discharge occurred, the HHA should adjust the claim to change the patient status to 01.

If the cause of the discharge in the next 30-day period is a transfer to another HHA before any visits were provided, the HHA should take care not to report patient status 06 on the claim. This would result in an incorrect partial period payment adjustment. If the cause of the discharge in the next 30-day period is the beneficiary’s death, the HHA should take care not to report patient status twenty on the claim. This would result in an incorrect date of death being recorded in Medicare systems and potentially affect claims from other providers.

Source: CMS

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