Home Health & Hospice Week

PECOS edit deadline continues to hang over providers' heads.

You'd better make sure you have your NPI ducks in a row or face billing delays. In less than four months, you'll no longer be able to put your own NPI in the Attending Provider NPI field.

So say a recent transmittal and MLN Matters article from the Centers for Medicare & Medicaid Services. "Effective for claims received on or after January 1, 2013, you must submit the National Pro-vider Identifier (NPI) of the attending provider in the Attending Provider Name and Identifiers Field (FL76) of your claims. That NPI must not be your billing NPI," CMS says in the MLN Matters article.

CMS previously had allowed providers to use their own NPI numbers in the field when they had trouble getting the numbers from referring physicians.

Exception: You can use your own NPI when the claim is for "institutional billing of influenza and pneumococcal vaccinations and their administrations when these are the only billed services on the claim," CMS explains.

Watch For PECOS Edit Deadline

Many providers are already using docs' NPIs appropriately, so problems caused by these new edits should be limited, hopes billing expert M. Aaron Little with BKD in Springfield, Mo. Agencies with referrals from Veterans Administration docs may have the most trouble.

Providers served by billing company Astrid Medical Services already do this, says owner Lynn Olson. "We verify the NPI with the physician's. If the name refers to a clinic or provider we return it to the provider for update," Olson explains. "Claims in the past have been rejected if they are for a group practice/clinic, that's why we upgraded our edits."

Bigger problem looms: CMS has yet to set a date for its so-called PECOS edits, in which it will check the doc's NPI against the PECOS database for a valid record. CMS issued a final rule earlier this year confirming the edits and has been issuing messages reminding providers about the requirement.

When those edits hit, home care providers will see claims denied when the referring physician isn't enrolled in PECOS. That could cause a cash flow crisis if the physician, who is unaffected by the denials, doesn't get into the PECOS system quickly.

CMS says it will give providers at least 60 days notice before turning on PECOS edits.

Note: The MLN Matters article is at www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7902.pdf and the transmittal is at www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2519CP.pdf.