NOA Guide
The Home Health NOA Deadline: What Agencies Need to Know
Since January 1, 2022, Medicare-certified home health agencies must submit a one-time Notice of Admission (NOA) within five calendar days of the start-of-care date. Miss the deadline and your agency loses payment for every late day. This guide covers how the NOA works, what late submission actually costs, and how agencies keep every admission on time.
What is a Notice of Admission (NOA)?
The NOA is a one-time submission (Type of Bill 32A) that establishes a home health admission period with Medicare. It replaced the Request for Anticipated Payment (RAP) on January 1, 2022 under the home health PPS final rule. Unlike the RAP, which was submitted for every 30-day payment period, the NOA is filed once per admission and covers all contiguous 30-day periods until the patient is discharged.
The NOA requires only limited information: the patient's identifying details, the admission date, and the agency's identifiers. It does not require a completed OASIS assessment or a signed plan of care to submit - which means there is rarely a legitimate operational reason to miss the deadline.
The five-calendar-day deadline
Agencies must submit and have the NOA accepted within five calendar days after the start of care. Calendar days include weekends and holidays. If the start of care is on a Monday, the NOA is due by end of day Saturday.
The clock starts at the start-of-care date - the first billable visit - not the referral date or the date the plan of care is signed.
What late NOA submission costs
When an NOA is submitted late without an approved exception, Medicare reduces payment for the first 30-day period by 1/30th for each late day, counted from the start-of-care date through the date the NOA is accepted. Those days are non-billable - the agency simply absorbs the loss.
For a typical 30-day period payment, each late day can cost roughly $65-$70, and a NOA that slips two weeks can wipe out nearly half the period's revenue. Across dozens of admissions a month, chronic NOA lateness becomes one of the largest silent revenue leaks in home health.
Exception requests
CMS allows agencies to request an exception when circumstances beyond the agency's control caused the late submission - for example, a Medicare systems outage, a newly issued or corrected beneficiary identifier, or other documented extraordinary circumstances. Exceptions are requested by adding the KX modifier and remarks to the claim, and the MAC decides whether to grant relief.
Staffing shortages, software problems at the agency, or simple oversight are generally not accepted as exception reasons - which is why prevention beats appeal.
How agencies keep every NOA on time
High-performing agencies treat the NOA as an intake-day task, not a billing task. Because the NOA needs no OASIS or signed orders, it can be prepared the moment a referral is accepted and submitted on the start-of-care date.
- Build the NOA automatically from referral and intake data so nothing is re-keyed
- Track the five-day countdown on every admission with escalating alerts
- Submit on day one whenever eligibility and admission details are confirmed
- Monitor acceptance - a submitted-but-rejected NOA still misses the deadline if not corrected in time
- Audit NOA timeliness weekly and trace every near-miss to its root cause
Frequently asked questions
When is the home health NOA due?
The NOA must be submitted to and accepted by the Medicare Administrative Contractor within five calendar days after the start-of-care date, counting weekends and holidays.
What is the penalty for a late NOA?
Payment for the first 30-day period is reduced by 1/30th per late day from the start-of-care date until the NOA is accepted. The late days are non-billable to the beneficiary and cannot be recovered without an approved exception.
Is the NOA required for every 30-day period?
No. The NOA is a one-time submission per admission. It covers all contiguous 30-day payment periods until the patient is discharged. A new NOA is required only after a discharge and readmission.
Does the NOA require a completed OASIS?
No. The NOA requires only basic admission information, so agencies can and should submit it before the comprehensive assessment or plan of care are finalized.
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