According to Medicare Administrative Contractors (MACs) NGS, CGS and Palmetto, home health claims are returning to provider in error with RC 19963 impacting home health claims with Notice of Admissions (NOA)/processed dates in January 2022.

On July 18, 2024, CMS issued Change Request 13684, Revisions to Home Health Edit Matching Claims to Notices of Admission, to notify home health agencies that there would be a purge of NOAs submitted more than 24 months from the date of admission. The implementation date for this change is January 6, 2025. The purpose of this Change Request (CR) is to ensure home health claims submitted more than 24 months from the date of admission are not returned in error due to NOA records being purged from the Fiscal Intermediary Shared System.

CMS is creating a fix for this issue that is scheduled to be put into production in the January 2025 System Release. This issue generally affects claims received by Medicare 18 months after the corresponding NOA was processed. Reason code 19963 assigns correctly if:

• There is no NOA on file for that admission;
• The NOA was submitted but was returned to the provider/rejected;
• The NOA was cancelled by the HHA and never resubmitted;
• The admission date does not match on the NOA and claim; or
• If that admission was closed by another claim with an earlier service date(s)