Good Morning MFS Bloggers, The following excerpt was taken from a recent CMS Transmittal. Happy reading!
Effective Date: October 1, 2010 (Phase 1); January 1, 2011 (Phase 2)
Provider Types Affected
This article is for free-standing and provider-based Home Health Agencies (HHAs) who bill Medicare Regional Home Health Intermediaries (RHHIs) for services provided to Medicare beneficiaries.
Background
The Centers for Medicare & Medicaid Services (CMS) is expanding claim editing to meet the Social Security Act requirements for the attending physician when a plan of treatment is needed and submitted from an HHA. In this document, the word ‘claim’ means both electronic and paper claims. The following are the only providers who can order/refer HHA beneficiary services:
– Doctor of medicine or osteopathy; and
– Doctor of podiatric medicine.
CMS claim editing is being expanded to verify that the attending physician on an HHA claim is eligible and is enrolled in Medicare’s PECOS. The editing expansion will be done in two phases:
• Phase 1 (October 1st, 2010 – December 31st, 2010) When a claim is received, CMS will determine if the attending physician is required for the billing service. If the attending physician’s NPI is on the claim, Medicare will verify that the attending physician is on the national PECOS file. If the attending physician NPI is not on the national PECOS file during Phase 1, the claim will continue to process but a message will be included on the remittance advice notifying the billing provider that claims may not be paid in the future if the attending physician is not enrolled in Medicare or if the attending physician is not of the specialty eligible to be an attending physician for HHA services.
• Phase 2 (On or after January 1, 2011) As stated above, Medicare will determine if the attending physician’s NPI is required for the billed service. If the billed service requires an attending physician and the attending physician’s NPI is not on the claim, the claim will not be paid. If the attending physician’s NPI is on the claim, Medicare will also verify that the attending physician is on the national PECOS file. If the attending physician is on the PECOS file, but not as specialty eligible to be an attending physician, the claim, during Phase 2, will not be paid.
