NOA (Notice of Admission)

The NOA must be accepted by the Medicare Administrative Contractor within 5 calendar days of the start of care, counting the start of care date itself as day zero and including weekends and holidays. When it is late, Medicare reduces the payment by a proportionate share, one-thirtieth of the full 30-day amount, for each day from the start of care through the day before the NOA is accepted, and the affected days cannot be billed. The penalty applies from day one of lateness and grows daily, so an NOA accepted two weeks late erases roughly half of the first period's payment. Providing care during the penalty window is still required; only the payment shrinks.

Unlike the RAPs it replaced, which were filed every payment period, the NOA is filed once per admission and covers every subsequent 30-day period until the patient is discharged. It is submitted as type of bill 32A with admission information, and the final claims for each period follow behind it. A new NOA is required only when a new admission begins, such as a readmission after discharge. Because all downstream claims depend on the NOA processing correctly, a rejected or returned NOA blocks the entire admission's billing until it is fixed.

CMS allows an exception to the late penalty when the delay was caused by circumstances beyond the agency's control. The recognized categories include natural disasters and similar events that disrupt operations, systems issues at the Medicare contractor or CMS, a newly Medicare-certified agency awaiting its billing credentials, and other circumstances CMS deems outside the agency's control. The agency requests the exception on the claim with supporting documentation. Exceptions are not granted for ordinary internal failures: staffing gaps, EHR hiccups the agency controls, or missed handoffs between intake and billing do not qualify.

High-performing agencies treat the NOA as a same-day or next-day task, not a day-4 one, because rejections consume the cushion. The working pattern: verify eligibility and the exact Medicare Beneficiary Identifier before submission, submit the NOA as soon as the start of care visit is confirmed, and monitor for rejections daily so corrections land inside the window. Track NOA timeliness as a standing metric with named ownership, and treat every late NOA as a process defect to root-cause. The penalty is uncapped within the period and entirely avoidable, which makes it one of the cleanest revenue-leak indicators in home health.