Home Health & Hospice Week

Plus: Use RAP non-payment as early warning of PECOS edit problem.

Home health agencies now have a little breathing room on the punishing claims edits that will check for ordering physicians’ PECOS enrollment.

"Due to technical issues, implementation of the Phase 2 ordering and referring denial edits is being delayed," the Centers for Medicare & Medi-caid Services says in an April 25 message to pro-viders. "CMS will advise you of the new implementation date in the near future." The delay is "temporary," CMS says.

When CMS does finally turn on the edits, you can head off a costly appeal by paying attention to how your RAPs pay.

If the attending physician National Provider Identifier (NPI) and name submitted on the Request for Anticipated Payment does not match the NPI and name in PECOS, the RAP will process with zero payment, stresses HHH Medicare Administrative Contractor CGS in an article on its website. "If this occurs, you may either: Cancel the RAP and resubmit a new RAP with the correct attending physician NPI and name to receive the RAP payment; OR Submit the final claim with the correct attending physician NPI and name to receive the full episode payment," CGS instructs.

On the other hand, if you submit a final claim with incorrect physician information, it will deny under the edits and you will have to submit an appeal — not an adjustment, reminds HHH MAC NHIC in a new message to providers.

Update: Specialty Code 01 for the physician was left out of the edits (see Eli’s HCW, Vol. XXII, No. 13). CMS "has confirmed that the Specialty Code ‘01’ should be included in the edit logic and is taking steps to implement changes to correct this issue," CGS reports.