NOAs will be required for patients within 5 days of their admission (RAPs are no longer required for billing periods that start on or after 1/1/2022, so you do not need to run the Billing Pre-Audit for RAPs beyond a 12/31/2021 date range). Medicare will not be accepting any NOAs until 1/3/2022.
NOAs are created via the Electronic Claims menu with a default HIPPS of 1AA11 once the Verbal Order or 485 with Primary Diagnosis is present for patients with a 2022 admit/artificial admit date. Refer to the NOA Creation FAQ for detailed instructions, which includes steps on updating the #146 Medicare NOA Option Set for your agency (for non-hosted agencies, contact Netsmart Client Support to obtain an option set). Confirm these steps have been followed prior to submitting NOAs in 2022.
MSP Billing
MSP NOAs must also be submitted within 5 calendar days after the start of an admission or the agency incurs a 1/30th final payment reduction for each day submitted late. Make sure your Medicare HH Biller is aware. Refer to the updated MSP FAQ for details on MSP claims.Medicare Advantage Payers Needing a RAP
If your agency bills Medicare Advantage Payers that plan to require PDGM RAPs, contact Support to extend their Finals Only Effective Date in the Insurance File (File > File Maintenance > Entity). A date up to 1/1/2025 may be entered. PPS 60-Day billing is no longer supported for periods beginning on or after 1/1/2022.Value Based Purchasing
On 1/8/2021 CMS announced the Home Health Value Based Purchasing (HHVBP) Model will be expanded to all Home Health Agencies nationwide. 2023 will be the first performance year and 2025 will be the first payment year. Refer to the HHVBP FAQ for more information.Review the Essentials PDGM Billing 2022 FAQ for additional details on Medicare Home Health and Medicare Advantage billing in 2022. Refer to the Essentials PDGM 2022 Q&A as a resource for 2022 PDGM question and answers.
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