CMS Proposes to Require a Notice of Admission
Monday, August 5, 2019
Posted by: Kyle Simon
Courtesy of the National Association for Home Care & Hospice (NAHC)
The Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate the advance, split percentage payments for all home health agencies (HHAs) in 2021. Therefore, agencies will no longer submit Requests for Anticipated Payment (RAPs) beginning January 1, 2021.
The RAP submission opens a home health prospective payment system (HHPPS) episode in the CMS Common Working File (CWF) and establishes the agency submitting the RAP as the primary agency for the episode. With the elimination of the split percentage payments and the RAP, CMS will need a mechanism to update the CWF.
CMS proposes to require HHAs submit a notice of admission (NOA) that will open a home health period under PDGM. The proposal would require that:
- An HHA submit the NOA for the initial 30-day period. Subsequent episodes and a discharge from the HHA will be identified by the applicable patient status codes currently used on claims.
- HHAs submit the NOA within five days of the admission to home health services.
- Failure to submit a timely NOA would result in a reduction to the 30-day Medicare payment amount, from the start of care date to the NOA filing date.
- The payment reduction would be 1/30th off of the full 30-day period payment amount for each day until the date the NOA is submitted.
- In the event that the 30 day period results in a LUPA (Low Utilization Payment Adjustment), visits rendered prior to the submission of the NOA would not be paid. CMS does not indicate whether a claim could be reduced from a 30-day unit to a per-visit LUPA if an NOA is submitted late.
- CMS proposes the NOA to be submitted through electronic data exchange (EDI) to Medicare contractors similar to the hospice Notice of Election (NOE).
CMS explains that a timely NOA is needed in order to support and enforce consolidated billing requirements and to prevent Medicare from paying claims to other providers/suppliers for services that are covered under the home health services consolidated billing rules.
The penalty is intended to incentivize agencies to submit the NOA timely. Since there is a payment associated with the receipt of the RAP, agencies typically submit RAPs as soon as possible. With a payment incentive dropped, CMS proposes to insert a penalty as an alternative way of encouraging timeliness.
Draft Possible Recommendations
- Agencies that in good faith submit a NOA within five days should not be penalized. Agencies should not be held liable for the time it takes the Medicare system to process the NOA and the agency to have to resubmit a corrected NOA.
- As an alternative, CMS should tie the penalty for a late submission to the losses incurred by a provider/supplier who has provided a bundled item or service if the outside provider/supplier could not have known the beneficiary was open to a home health plan of care because the agency did not submit the NOA timely. CMS’s current policy does not require HHAs reimburse providers/suppliers for bundled services if an arrangement is not place with the provider/supplier. Under this alternate penalty policy, the agency’s liability would not be predicated on whether an arrangement was in place but if the NOA was not submitted timely.
NAHC is seeking input from providers on additional concerns and recommendations for solutions for the proposed NOA.