Tackling the Notice of Admission (NOA) Trap with Home Health Billing

The world of home health billing is all about timing. The billing process for home health can be streamlined if the claims are accurately submitted. However, this is not as easy as it seems. For instance, home health clinics lose a lot of money when they face the Notice of Administration (NOA) problem. 

Defining Notice of Admission (NOA) 

It has been observed that the Request for Anticipated Payment (RAP) is nothing but the alternative of NOA. Moreover, NOA, which has replaced RAP, is useful for pre-payment purposes. A Request for Anticipated Payment (RAP) is a mandatory, "no-pay" claim submission by home health agencies to Medicare at the start of a 30-day period of care. 

NOA is an electronic notification which the home health agencies submit to Medicare to inform that a beneficiary has started to receive care. The CMS has replaced the RAP program with NOA, which is why the error margin has drastically reduced. However, there is a mandate that home health agencies need to submit a one-time NOA within five calendar days when the care starts. Hence, failure to meet this can trigger claim denials significantly. 

Reason the 5 Day Deadline is a Major Issue 

The primary home health billing problem doesn’t work in a short timeframe; it’s a clinical billing handoff which should occur within 120 hours. Let’s dive into the major problems this deadline cause: 

• Documentation lag: The NOA needs a valid doctor’s order and the proof that the patient has completed their first visit. If a clinician cannot sync their notes, the clock keeps ticking.  
• Eligibility issues: It takes a lot of time to verify Medicare Advantage versus Traditional Medicare. If someone identifies a wrong payer and the NOA isn’t sent to the correct Medicare Administrative Contractor (MAC), there is an invalid submission.  
• Errors and system latency: Medicare’s Direct Data Entry (DDE) system experience “Return to Provider” (RTP) error for all the minor mismatch of data. So, if the in-house staff cannot catch RTP errors until day 6, they can face penalty. 

How to Avoid Errors in Home Health Billing 

NOA is a one-time notification which establishes patient care under Medicare Home Health Benefit. Though it covers the 30-day care period until the patient is discharged, it doesn’t trigger the upfront payment. So, one needs to be extremely careful to manage the NOA process simply because Medicare calculates the late penalty of NOA with extreme accuracy. For every day the NOA is late, the agency loses 1/30^th of the total care reimbursement. The in-house home health experts wear many hats such as they tackle the administrative tasks and also take care of their patients. So, because of that, the clinics face several challenges such as: 

High Training and Turnover Cost 

The complexity of the NOA requirements and the Patient-Driven Grouping Model (PDGM) demands specialized knowledge. The in-house billing team has several years of experience with them, but if they focus on this, then patient care may get hampered. 

The Jack of All Trades 

The in-house billing teams are pulled into HR tasks, answering phones, and front-desk duties. As the NOA deadlines include holidays and weekends, getting sick or taking a day off can result in NOA denials. 

Lack of Monitoring Tools 

Most mid to small sized home agencies lack the customized dashboards needed to flag all the “at-risk” NOAs. The in-house staff rely on manual spreadsheets which doesn’t provide all the detailed tracking needed to prevent penalty. 

Why Outsourcing to Home Health Billing Companies is a Viable Option 

In today’s competitive world, agencies need to shift their focus from managing the paperwork process to delivering patient care. Outsourcing provides several options such as: 

24/7 Coverage and Precision 

Outsourced services hire dedicated specialists whose job is to submit the NOAs so that the in-house staff can focus on patient care. However, as these teams work in a different time zone and have robust staffing weekends, the “5-day clock” isn’t ignored. They make sure that if a patient gets admitted on a friday, then the NOA gets processed on Sunday. 

Technology-Driven Prevention Process 

The best home health experts use advanced software like Homecare Homebase, WellSky Home Health and many more which integrate into the clinic’s EHR system to scrub data. Moreover, they identify mismatches with MBI (Medicare Beneficiary Identifier) or missing doctor’s signature which helps in the correction process before the 5-day window closes. 

Scalability and Cost-Effectiveness 

Outsourcing is beneficial to convert all your fixed overhead costs when it comes to benefits, salaries and office spaces. The billing experts charge a very small amount of revenue so that clinics can grow seamlessly.  

It can be observed that the 5-day NOA deadline is a gatekeeper and if the in-house team struggles with the daily administrative chaos, the outsourced services have the expertise to maintain a clean claim rate and 100% NOA compliant. If the agency is seeing “Late NOA” on your remittance, it is high time to re-evaluate your billing strategy and partner with an expert company. These services can reduce your operational costs by 80% and provide 10% buffer resources to make sure no employee shrinkage occurs. So, outsourcing a home health billing expert can be considered a feasible option in that manner.