The Notice of Admission (NOA) is the one-time filing that opens a Medicare home health period of care — and if it is late, it costs the agency real money on every day of delay. Since January 1, 2022, home health agencies must submit a single NOA within 5 calendar days of the start of care. Miss that window, and Medicare reduces the 30-day period payment by one-thirtieth for each day between the start-of-care date and the date the NOA is accepted. On a $2,700 period, that is roughly $90 lost per day late — a preventable reduction that comes straight off the top of the episode.
This guide explains what the NOA replaced, exactly how the 5-day rule and the late-filing reduction work, when the exceptions apply, and how agencies keep every NOA on time. Every rule below traces to CMS so your billing and intake teams can verify it directly.
What the Notice of Admission Replaced
Before 2022, home health agencies submitted a Request for Anticipated Payment (RAP) to open a period and receive a portion of the payment up front. CMS phased out that split-percentage payment and, in the CY 2022 Home Health Prospective Payment System final rule, replaced the RAP with a one-time Notice of Admission effective January 1, 2022. The change is documented in the CY 2022 Home Health PPS final rule, the authoritative source for the requirement.
The NOA is not a payment request — it carries no up-front money. Its job is to establish the beneficiary's home health period in Medicare's system, lock in the primary payer, and start the clock on the period of care. That single administrative document is now a gate every episode must pass through cleanly.
The 5-Day Filing Rule
The core requirement is simple to state and easy to miss: the agency must submit the NOA so that it is received and accepted within 5 calendar days after the start-of-care date. The start-of-care date is day zero; the agency has through the fifth calendar day to get an accepted NOA on file.
"Accepted" is the word that matters. An NOA that is submitted on time but returned to the provider (RTP'd) for an error — a wrong Medicare Beneficiary Identifier, an eligibility mismatch, an occurrence-code problem — is not a timely NOA until a corrected version is accepted. That is why timely filing is really about *clean* filing: the countdown does not stop just because you hit submit.
The Late-NOA Payment Reduction (How It's Calculated)
When an NOA is not accepted within the 5-day window, Medicare applies a payment reduction to the first 30-day period of care. The reduction equals one-thirtieth (1/30) of the full 30-day period payment for each day from the start-of-care date until the day the NOA is submitted and accepted.
- File on time (accepted within 5 days): no reduction.
- File late: the period payment is reduced by 1/30 per day of delay, counting from the start-of-care date.
- The later the acceptance, the larger the reduction — a two-week delay can erase a meaningful share of the entire period's payment.
Because the reduction is tied to the number of days late, every single day of delay has a dollar value. That reframes the NOA from a clerical task into a daily revenue deadline, and it is why high-performing agencies aim to file within 24–48 hours of the start of care rather than using the full five days.
The One-Time NOA and Continuous Billing
Unlike the old RAP, which was filed for each payment episode, the NOA is filed once per admission. A single accepted NOA establishes the home health period and covers the contiguous 30-day periods that follow, with no new NOA required as long as the patient remains under care without a qualifying break. The agency then submits its 30-day claims against that established period.
A new NOA is generally required only when the patient is discharged and later readmitted, starting a new period of care. Knowing exactly when a new admission — and therefore a new NOA — is triggered is a common source of avoidable reductions, especially around transfers and discharges.
Exceptions for Circumstances Beyond Your Control
CMS built in relief for delays the agency could not prevent. An agency may request an exception to the timely-filing requirement when the late NOA resulted from circumstances beyond its control — for example, a Medicare systems or contractor issue, a natural disaster, or newly established agencies waiting on Medicare enrollment. When a valid exception is granted, the payment reduction is waived.
Exceptions are not automatic and not a workflow. They are a narrow safety valve for genuine, documented events — not a substitute for a reliable on-time process. Agencies should document the qualifying circumstance thoroughly and request the exception promptly, while treating on-time filing as the default that protects the vast majority of episodes.
How to Keep Every NOA On Time
Late NOAs are almost always a process failure, not a knowledge gap — which means they are fixable with discipline.
- Assign clear ownership. One role owns NOA submission with a named backup, so an absence never lets the clock run out.
- Verify eligibility before the start of care. Confirm the Medicare Beneficiary Identifier, eligibility, and primary payer at intake so the NOA is accepted the first time instead of being returned.
- Submit within 24–48 hours, not on day five. Filing early leaves room to correct a returned NOA and still land inside the window.
- Track acceptance, not just submission. Monitor for RTPs daily and correct and resubmit immediately — a submitted-but-returned NOA is still a late NOA until it is accepted.
- Reconcile admissions to NOAs. A simple daily check that every new start of care has an accepted NOA catches the one that slipped before it becomes a reduction.
- Watch the readmission trigger. Build discharge-and-readmit scenarios into your workflow so a new period always gets its new NOA on time.
Agencies that operationalize these steps rarely take an NOA reduction; those that rely on memory and the full five-day cushion take them repeatedly. Because the reduction is preventable, it is exactly the kind of leakage a disciplined revenue cycle and proactive accounts receivable follow-up are built to eliminate.
Frequently Asked Questions
What is a Notice of Admission in home health?
The Notice of Admission (NOA) is a one-time administrative filing that establishes a Medicare home health period of care. It replaced the Request for Anticipated Payment (RAP) on January 1, 2022. The NOA carries no up-front payment — it locks in the beneficiary's period and primary payer so the agency can bill its 30-day claims against it.
When is the home health NOA due?
The NOA must be received and accepted within 5 calendar days after the start-of-care date. The start-of-care date is counted as day zero, giving the agency through the fifth calendar day. Because a returned NOA is not "accepted," agencies should file early enough to correct any errors within that window.
What is the penalty for a late NOA?
For a late NOA, Medicare reduces the first 30-day period payment by one-thirtieth (1/30) of the full period amount for each day from the start-of-care date until the NOA is submitted and accepted. There is no penalty when the NOA is accepted within 5 days; the reduction grows with each additional day of delay.
Does an agency file an NOA for every 30-day period?
No. The NOA is filed once per admission, not per period. A single accepted NOA covers the contiguous 30-day periods of a continuous home health stay. A new NOA is generally needed only when a patient is discharged and later readmitted, which starts a new period of care.
Medeoan helps home health agencies eliminate late-NOA reductions with reliable intake verification, same-day submission, and daily acceptance tracking — so the clock never runs out on a period's payment. If NOA reductions are showing up on your remittances, our revenue cycle management, accounts receivable follow-up, and denial management teams can help you close the gap. For a related revenue-protection read, see our guide to avoiding unnecessary PDGM LUPAs.