Home Health & Hospice Week

Starting next month, you'll find out how big of a bite the PECOS requirement is going to take out of your payments in the new year. As of Oct. 4, the requirement that your claims include a referring/ ordering physician who is enrolled in PECOS will begin.

In phase 1, which lasts from October to the end of the year, home health agencies will get informational edits telling them which claims are lacking information for physicians enrolled in the system.

Claims still will process and pay normally, however, CMS says in newly updated CR 6856. In phase 2, which begins Jan. 3, "the claims will not be paid if the required information is missing or not accurate on the claim," the transmittal says.

More confusion: HHAs already have been confused over when the PECOS edits will take place and whether payments can be recouped retroactively for missing physician information. CMS doesn't exactly help matters by including a new statement in the CR that says "FISS shall determine if attending physician provider is required on a claim which has a statement from date of service on or after July 1, 2010." But in the same transmittal, CMS says, "the July 1, 2010, date has no impact on FISS coding as this date refers to the date in the statute."

Resource: The revised transmittal is at www.cms.gov/transmittals/downloads/R765OTN.pdf and a MLN Matters article is at www.cms.gov/MLNMattersArticles/downloads/MM6856.pdf.