CMS fix for home health claims bounced when the Notice of Admission ages out of the system lands April 2027

On October 8, 2026, CMS issued transmittal R13996OTN, "Home Health Reason Code 19963 Edit – Notice of Admission Not Found." It takes effect April 1, 2027, with implementation on April 5, 2027. The transmittal adds that, unless it says otherwise, the effective date is the date of service (transmittal R13996OTN, PDF).

The problem, in CMS's words

Medicare Administrative Contractors flagged home health claims (bill type 032x) that were returned under reason code 19963. These claims had From and Through dates within 24 months of the admission date but were received more than 24 months after admission. By then, the transmittal says, the Notice of Admission record had been purged from the Fiscal Intermediary Shared System. With no NOA on file, the claim couldn't process.

A worked example (ours, not CMS's): a patient admitted in May 2025 is still on service. A 30-day period that ends in April 2027 sits inside the 24-month window. If the claim for that period isn't received until June 2027, it lands after the 24-month mark, and the NOA it depends on may already be gone. Because CMS ties the effective date to the date of service, it's this kind of claim, with dates of service from April 1, 2027, that the fix is written for. For earlier dates of service received late, ask your MAC.

The fix

The business requirement is short. When a home health claim has no matching NOA, its From and Through dates fall within 24 months of admission, and it's received after that 24-month mark, FISS is to accept the claim and pass the claim's admission date to the Home Health Pricer in the "receipt date" field. The transmittal says an earlier instruction, CR 13684, "still stands" and that this one adds to it. It says the CR "contains no new policy."

What's not in it

• No MLN Matters article. The transmittal lists provider education as "None," and CMS's 2026 transmittals index shows no MLN Matters link for it.
• A numbering gap: the PDF names Change Request 14605, but the CMS index leaves the CR column blank.
• Nothing changes before April 2027. Until then, agencies that hit 19963 on late claims for long-stay patients should take it to their MAC. Illinois agencies bill Palmetto GBA, Jurisdiction M (CMS JM page).

Who should care

Billing teams at agencies with patients on service for two years or more, and anyone carrying late or held claims for those patients. The trigger is late receipt, not the length of stay alone.

Sources

• CMS, transmittal R13996OTN
• CMS, transmittal listing
• CMS, 2026 transmittals index
• Independent summary, PolicyChanges.app
• CMS, A/B MAC Jurisdiction M (covers Illinois home health and hospice)

Track every MAC change: our Medicare jurisdictions tracker lists CMS and MAC bulletins by jurisdiction, including Palmetto GBA, Jurisdiction M for Illinois.

It is general information, not clinical, billing or legal advice.*

Drafted with AI assistance from primary sources and reviewed by Monsaur Othman before publication. Read how we use AI, our editorial policy and our corrections policy.

Informational only, not billing, legal or clinical advice. Check the linked primary source and your Medicare Administrative Contractor.