Corrections to Home Health Billing: The Medicare Benefit Policy

Before the implementation of the one-time home health Notice of Admission (NOA) in calendar year 2022, every claim for a home health period of care first required the submission of a Request for Anticipated Payment (RAP). Billings for denial notice (Type of Bill (TOB) 320 reporting condition code 21) were excluded from this requirement for a prior RAP because no payment was requested on the claim. Claims with TOB 320 and condition code 21 also did not create or update period of care records in original Medicare's Common Working File (CWF) system. Due to an oversight in the NOA implementation, billings for denial were not excluded from the requirement for all claims to be preceded by an NOA that creates an election period in CWF. The requirements below correct this, ensuring claims with TOB 320 and condition code 21 are accepted when an election period is not present and that these claims trigger no updates to HH periods of care.