Important Information Regarding Exception Requests for Late Home Health Notice of Admissions

Palmetto GBA has seen an increase of invalid late Home Health Notice of Admissions (NOAs) exception requests. Home health agencies (HHAs) are to ensure they accurately submit late NOA exceptions. Please share the below information with your billing staff.  

• HHAs are requesting late NOA exceptions when the NOA was received timely.  This is done by applying the KX modifier and/or remarks unnecessarily on claims. This will cause the claim to suspend, delay its processing and the claim may be returned for correction.
• When there is a Medicare system issue that caused a NOA to be late, Palmetto GBA provides (when available) exact remarks on the Claims Payment Issues Log the HHAs are to submit on the corresponding claims. If the provided remarks are available and not used, it may cause delays in processing the exception or a denied exception request and lost reimbursement. 
• Late NOAs may affect multiple period or care claims depending on how late the NOA is received. An NOA received 10 days from the admission date, would only require an exception request, if applicable, on the first 30-day period claim. If the  NOA was received 45 days late and there are two or more periods of care in the home health admission, a late exception request is required for the first two periods of care claims.

Resources

• Late Notice of Admission: The Exception Process
• Home Health Notice of Admission (NOA) Frequently Asked Questions (FAQ) (PDF)
• Medicare Claims Processing Manual, Chapter 10 — Home Health Agency Billing (PDF)
  • 10.1.10.3 — Submission of the Notice of Admission (NOA)
  • 40.1 — Notice of Admission (NOA)
  • 40.2 — HH PPS Claims
• Medicare Benefit Policy Manual, Chapter 7 — Home Health Services (PDF)
  • 10.4 — Submission of the Notice of Admission (NOA), and 
  • 10.5 — Requirements for Submission of the NOA